Aims. Robotic-assisted total knee arthroplasty (RA-TKA) has been introduced to provide accurate bone cuts and help achieve the target knee alignment, along with symmetric gap balancing. The purpose of this study was to determine if any early clinical benefits could be realized following TKA using robotic-assisted technology. Methods. In all, 140 consecutive patients undergoing RA-TKA and 127 consecutive patients undergoing conventional TKA with minimum six-week follow-up were reviewed. Differences in visual analogue scores (VAS) for pain at rest and with activity, postoperative opiate usage, and length of stay (LOS) between the RA-TKA and conventional TKA groups were compared. Results. Patients undergoing RA-TKA had lower average VAS pain scores at rest (p = 0.001) and with activity (p = 0.03) at two weeks following the index procedure. At the six-week interval, the RA-TKA group had lower VAS pain scores with rest (p = 0.03) and with activity (p = 0.02), and required 3.2 mg less morphine equivalents per day relative to the conventional group (p < 0.001). At six weeks, a significantly greater number of patients in the RA-TKA group were free of opioid use compared to the conventional TKA group; 70.7% vs 57.0% (p = 0.02). Patients in the RA-TKA group had a shorter LOS; 1.9 days versus 2.3 days (p < 0.001), and also had a greater percentage of patient discharged on postoperative day one; 41.3% vs 20.5% (p < 0.001). Conclusion. Patients undergoing RA-TKA had lower pain levels at both rest and with activity, required less opioid medication, and had a shorter LOS

Introduction. Opioid abuse is a national epidemic. Traditional pain management after total knee arthroplasty (TKA) relied heavily on opioids. The evidence that in-hospital multimodal pain management (MMPM) is more effective than opioid-only analgesia is overwhelming. There has been little focus on post-discharge pain management. The purpose of this study was to determine whether MMPM after TKA could reduce opioid consumption in the 30-day period after hospital discharge. Methods. This was a prospective, two-arm, comparative study with a provider cross-over design. The first arm utilized a standard opioid-only (OO) prn regimen. The second arm utilized a 30-day MMPM regimen (standing doses of acetaminophen, metaxalone, meloxicam, gabapentin) and opioid medications prn. Surgeons crossed over protocols every four weeks. The primary outcome measure was VAS pain score. Secondary outcome measures included morphine milligram equivalents (MME) consumed, failure of the protocol, and manipulation under anesthesia (MUA). A pre-hoc power analysis was performed for the primary outcome measure and an intent-to-treat analysis was done utilizing a longitudinal mixed model. Results. There were 43 patients in the OO cohort and 39 patients in the MMPM cohort. There was no difference in the baseline demographics or preoperative scores (p=0.94). There was no clinically meaningful difference in VAS score between the two groups at any time. The average opioid consumption at 30-days was 469 and 344 MME's for the OO and MMPM cohorts, respectively (p=0.026). 19/43 (44.2%) patients in the OO cohort failed vs. 4/39 (10.3%) in the MMPM cohort (p=0.002). There was 1 MUA in the OO and none in the MMPM cohort (p=0.338). Discussion. A 30-day post-discharge multimodal pain regimen reduced opioid use after TKA. Opioid-only regimens are at an increased risk of failure to control pain. As a result of this study, multimodal pain management after hospital discharge is standard at our institution

Aims

Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction.

Aims

Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA.