A Risk Factor Out of Control: Commentary on an article by Alon Ben-Ari, MD, et al.: "Preoperative Opioid Use Is Associated with Early Revision After Total Knee Arthroplasty. A Study of Male Patients Treated in the Veterans Affairs System".

Abstract

Optimal pain control following total knee arthroplasty (TKA) presents a challenging balance between effectiveness and risk, and warrants consideration and concern from both patients and surgeons. Great attention has been given recently to optimizing postoperative pain control through multimodal pain management protocols developed in an attempt to minimize use of opioid pain medications. While opioid pain medications can be effective for controlling postoperative pain, their use is not benign. Postoperative pain management can be made even more difficult by the preoperative use of opioids by patients about to undergo TKA. Preoperative opioid use has been shown to be associated with poorer postoperative pain control, an increase in postoperative complications, and a decrease in postoperative functional outcome measures1,2. Ben-Ari et al. build on prior literature regarding the effect of preoperative opioid use on a TKA population by evaluating its association with early revision due …