Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, California.
Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia.
J Arthroplasty. 2018 Feb;33(2):331-336. doi: 10.1016/j.arth.2017.09.001. Epub 2017 Sep 13.
Prolonged opioid use following total knee arthroplasty (TKA) has not been extensively studied.
A cohort study of primary TKA for osteoarthritis using an integrated healthcare system and Total Joint Replacement Registry (January 2008-December 2011) was conducted. Opioid use during the first year after TKA was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total postsurgical OME per 90-day exposure periods were categorized into quartiles. The end point was aseptic revision surgery. Survival analyses were conducted and hazard ratios (HRs) were adjusted for age, gender, prior analgesic use, opioid-related comorbidities, and chronic pain diagnoses.
A total of 24,105 patients were studied. After the initial 90-day postoperative period, 41.5% (N = 9914) continued to use opioids. Also, 155 (0.6%) revisions occurred within 1 year and 377 (1.6%) within 5 years. Compared to patients not taking any opioids, patients using medium-low to high OME after the initial 90-day period had a higher adjusted risk of 1-year revision, ranging from HR = 2.4 (95% confidence interval, 1.3-4.5) to HR = 33 (95% confidence interval, 10-110) depending on the OME and time period.
Patients who require opioids beyond 90 days after TKA warrant close follow-up.
全膝关节置换术后（TKA）长期使用阿片类药物尚未得到广泛研究。
对使用综合医疗系统和全关节置换登记处（2008 年 1 月至 2011 年 12 月）进行的原发性骨关节炎 TKA 队列研究。TKA 后第一年的阿片类药物使用是本研究的暴露因素，计算了累积每日口服吗啡等效剂量（OME）。将术后每 90 天暴露期的总 OME 分为四分位。终点为无菌翻修手术。进行生存分析，并根据年龄、性别、术前镇痛药物使用、与阿片类药物相关的合并症和慢性疼痛诊断调整危险比（HR）。
共研究了 24105 名患者。在最初的 90 天术后期间，41.5%（N=9914）继续使用阿片类药物。此外，1 年内有 155 例（0.6%）和 5 年内有 377 例（1.6%）发生翻修。与不服用任何阿片类药物的患者相比，在最初 90 天之后使用中低至高 OME 的患者，1 年翻修的调整风险更高，范围从 HR=2.4（95%置信区间，1.3-4.5）到 HR=33（95%置信区间，10-110），具体取决于 OME 和时间。
TKA 后需要阿片类药物超过 90 天的患者需要密切随访。
