Association of Preoperative Opioid Use and Postoperative Opioid Requirement in Revision Total Knee Arthroplasty.

Purpose The characterization of opioid usage in revision total knee arthroplasty (rTKA) remains incomplete. This study aimed to evaluate postoperative opioid consumption, measured in morphine milligram equivalents (MME), as well as hospital length of stay and discharge destinations such as home versus skilled nursing facility following revision TKA. Methods Patients who underwent rTKA between 2010 and 2018 were assessed for preoperative opioid use and monitored for 24 months postoperatively. Patients were stratified into opioid-naïve or opioid-tolerant categories. Demographic data were collected, and opioid prescriptions and average MME were compared between the two groups. Results Out of 173 patients who underwent rTKA, 91 (53%) were categorized as opioid-tolerant, with an average preoperative MME of 23.5 mg/day. Postoperatively, opioid-tolerant patients exhibited higher daily MME at 3 and 6 months and were more likely to receive opioid prescriptions at 6 and 12 months. Additionally, the opioid-tolerant group experienced a significantly prolonged postoperative hospital stay at 4.82 days versus 3.78 days (p=0.004) and were more inclined to be discharged to a skilled nursing facility (rather than home) compared to the opioid-naïve group, at 40.7% versus 18.3% (p=0.004). Conclusions Opioid-tolerant patients demonstrated elevated postoperative MME requirements, longer recovery periods, and an increased likelihood of skilled nursing facility discharge, underscoring the challenges associated with opioid tolerance in the post-rTKA setting. Both groups showed a reduction in opioid usage at 3 months postoperatively, reaching a plateau at 6 months. These insights can inform revision surgeons in patient counseling and managing expectations.