Predictors of pain medication use for arthroplasty pain after revision total knee arthroplasty.
OBJECTIVE
Our objective was to study the use of pain medications for persistent knee pain and their predictors after revision total knee arthroplasty (TKA).


METHODS
We examined whether demographic (gender, age) and clinical characteristics [BMI, co-morbidity measured by the Deyo-Charlson index (a 5-point increase), anxiety and depression] predict the use of NSAIDs and narcotic pain medications 2 and 5 years after revision TKA. Multivariable logistic regression adjusted for these predictors as well as operative diagnosis, American Society of Anesthesiologists class and distance from the medical centre.


RESULTS
A total of 1533 patients responded to the 2-year questionnaire and 881 responded to the 5-year questionnaire. NSAID use was reported by 13.4% (206/1533) of patients at 2 years and 16.7% (147/881) at 5 years. Narcotic medication use was reported by 5.4% (83/1533) of patients at 2 years and 5.9% (52/881) at 5 years. Significant predictors of the use of NSAIDs for index TKA pain at 2 and 5 years were age >60-70 years [odds ratio (OR) 0.62 (95% CI 0.39, 0.98) and 0.46 (0.25, 0.85)] compared with age ≤60 years and a higher Deyo-Charlson index [OR 0.51 (95% CI 0.28, 0.93)] per 5-point increase at 5-year after revision TKA. Significant predictors of narcotic pain medication use for index TKA pain were age >60-70 years [OR 0.41 (0.21, 0.78)] and >70-80 years [0.40 (95% CI 0.22, 0.73)] at 2 years and depression [OR 4.58 (95% CI 1.58, 13.18)] at 5 years.


CONCLUSIONS
Younger age and depression were risk factors for the use of NSAIDs and narcotic pain medications for index TKA pain at 2- and 5-years after revision TKA.
Medicine Service and Center for Surgical Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Department of Medicine, School of Medicine and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Medicine Service and Center for Surgical Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Department of Medicine, School of Medicine and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Medicine Service and Center for Surgical Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Department of Medicine, School of Medicine and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Jasvinder.md@gmail.com.
Jasvinder A
JA
Singh
Medicine Service and Center for Surgical Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Department of Medicine, School of Medicine and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL and Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
David G
DG
Lewallen
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003863:Depression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics
NSAIDs; narcotic; opioid; pain medication; predictors; revision TKA; total knee replacement