Racial Differences in Perioperative Pain Management After Total Knee Arthroplasty

Racial differences have been reported in the utilization of total knee arthroplasty (TKA), and there exists differences in pain management between African American and Caucasian patients. There are insufficient data concerning racial differences in perioperative pain management for patients after TKA for osteoarthritis of the knee. This is a retrospective study of 804 African American patients who had primary TKA between 2013 and 2022 at a single academic medical center. Patients were matched, 2:1, to Caucasian patients having TKA using American Society of Anesthesiologists score, age, gender, and body mass index. Demographic data and perioperative variables, including pain scores, morphine equivalents required at multiple time points, operative time, length of stay, and opioid refills were evaluated. A significantly higher proportion of African American than Caucasian patients had opioid medication prescribed within 90 days preoperatively (38% African American vs. 22% Caucasian patients). African American patients had significantly higher preoperative pain scores (3.28 vs. 2.26) than Caucasian patients and received significantly higher doses of morphine equivalents both preoperatively and postoperatively. The proportion of African American patients with opioid medication refills within 90 days postoperatively was significantly higher than Caucasian patients (73% vs. 33%). However, African American patients received significantly less intraoperative morphine equivalents. The reasons for the racial differences in perioperative pain management after TKA at one medical center are unknown and require additional study. However, these results suggest that pain management protocols, including standardized opioid medication, be implemented for patients of all races after primary TKA. (Journal of Surgical Orthopaedic Advances 34(3):152-155, 2025)

Key words: pain, opioid, racial differences, total knee arthroplasty, prescription