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. 2025 May 24:33:101714.
doi: 10.1016/j.artd.2025.101714. eCollection 2025 Jun.

Opioid Use Following Primary Unilateral Total Knee Arthroplasty Varies With Age

Shah Fahad  1 , Jason A Bryman  1 , Michael A Behun  1 , Maryam Salimi  2 , Olivia Vyge  1 , Nina Rosen  1 , Todd Miner  1 , Jason M Jennings  1   3
Affiliations

Opioid Use Following Primary Unilateral Total Knee Arthroplasty Varies With Age

Shah Fahad et al. Arthroplast Today. .

Abstract

Background: Reducing unused prescribed opioids following arthroplasty procedures remains a challenge. The relationship between opioid consumption and age has seldom been investigated. We hypothesize that older patients consume fewer narcotic medications than younger patients following primary unilateral total knee arthroplasty (TKA).

Methods: We retrospectively reviewed 506 primary unilateral TKA patients for perioperative opioid utilization. Patients were stratified by age at the time of operation (40-49, 50-59, 60-69, 70-79, 80+). Narcotic medications used in-house and in the 3 months following discharge were calculated and converted to morphine milligram equivalents (MMEs). Patients receiving an opioid prescription after 90 days postoperatively were classified as persistent opioid users (POUs). The duration of opioid use was calculated for non-POU patients as the time between surgery and their last opioid prescription. Differences in in-patient MME, outpatient MME, and POU were analyzed. The use of psychiatric medications, tetrahydrocannabinol (THC), and nicotine was also documented.

Results: Younger patients were more likely to be chronic preoperative opioid users (P = .0074) and more likely to use antidepressants (P < .0001), nicotine (P = .0041), and THC (P < .0001). Younger age groups had the highest percentage of POU, which decreased with each subsequent decade (P = .0079). Younger patients also had an increased duration of opioid use (P < .0001) and total outpatient MME (P < .0001) within 3 months postoperatively.

Conclusions: Younger patients demonstrated higher postoperative opioid use following primary TKA; however, this was likely influenced by confounding factors such as preoperative opioid use, nicotine, THC, and antidepressant use. While age alone may not independently predict increased opioid consumption, these findings highlight the importance of identifying and managing modifiable risk factors to optimize pain control. Further research with larger cohorts is needed to better isolate the impact of age.

Keywords: Age; Opioids; Pain management; Total knee arthroplasty.

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Figures

Figure 1
Figure 1
Persistent opioid use rates across different age groups following total knee arthroplasty (TKA), demonstrating the highest opioid consumption in younger patients (40–49 years). Statistical significance: P = −.0079.
Figure 2
Figure 2
In-house morphine milligram equivalent (MME) use across age groups.
Figure 3
Figure 3
Duration of opioid use (DOU) varies with age: Younger patients have longer use.
Figure 4
Figure 4
Total MME use varies with age: Younger patients have higher opioid consumption.
See this image and copyright information in PMC

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