Developing and Testing an Opioid Taper Intervention Before Total Knee Arthroplasty - PROJECT SUMMARY
Osteoarthritis of the knee is one of the most common causes of chronic pain in the US, and a common reason
that patients take long-term opioids for pain. Total knee arthroplasty is often used to treat advanced knee
osteoarthritis, with nearly a million patients undergoing total knee arthroplasty in the US each year. Many
patients who undergo total knee arthroplasty are taking opioids preoperatively. However, preoperative opioid
use is associated with worse postoperative pain, higher complication rates, and higher postoperative opioid
use. Even low dose opioids can induce dependence and hyperalgesia, so postoperative pain can be harder to
control in patients who have been taking chronic opioids, which can then lead to more difficult rehabilitation
after surgery. Tapering opioids preoperatively holds potential to improve outcomes in total knee arthroplasty by
counteracting these negative effects of opioids. However, the existing literature on preoperative opioid taper is
limited. Several small retrospective studies have suggested a benefit, but detailed preoperative taper protocols
have not been published, and high quality prospective studies have not been conducted. This proposal looks to
advance the field of preoperative opioid tapering. Aim 1 will develop and refine a preoperative opioid taper
protocol for patients undergoing total knee arthroplasty. Aim 2 will assess the feasibility of preoperative opioid
taper intervention in a pilot randomized trial. At the completion of the pilot trial in Aim 2, the intervention will be
ready to be tested for efficacy in a multicenter randomized control trial as the next step in this research. The
overall goal of this 4-year Mentored Patient-Oriented Research Career Development Award (K23) proposal is
to support Kevin Riggs, MD, MPH to become an independent investigator in the field of improving arthroplasty
outcomes, with a focus on pain and opioid use. This award will provide comprehensive mentoring, training, and
research experience to facilitate Dr. Riggs’s progression toward becoming an independent investigator.
Specifically, Dr. Riggs will gain expertise in developing interventions, clinical trial design, and evaluation of
functional status and other patient-reported outcome measures. This will position Dr. Riggs to become a leader
in improving surgical outcomes for patients undergoing arthroplasty.
