Preoperative Predictors of Postoperative Opioid Usage, Pain Scores, and Referral to a Pain Management Service in Total Knee Arthroplasty

HSS Journal Online First Article

Trevor R. Banka, MD

Hospital for Special Surgery

Allison Ruel, BA

Hospital for Special Surgery

Kara Fields MS,

Hospital for Special Surgery

Jacques T. Ya Deau, MD, PhD
Jacques T. Ya Deau, MD, PhD

Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College

Geoffrey H. Westrich, MD
Geoffrey H. Westrich, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Research Director of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery


Little is known about preoperative predictors of postoperative pain and referral to a recuperative pain management service after total knee arthroplasty (TKA).

We sought to identify the preoperative predictors of postoperative pain scores, referral to a pain management service, and narcotic usage in patients undergoing primary total knee arthroplasty.

We performed a prospective cohort study of 97 TKAs from a single surgeon. Pre and 6-week postoperative WOMAC, visual analog pain scale (VAS) scores, narcotic usage, and catastrophizing pain scores were collected.

After adjusting for all other variables, higher age and catastrophizing pain scores were associated with lower odds of postoperative opioid usage. Increasing age and BMI were associated with lower odds of being referred to pain management. There was no relationship between self-reported preoperative pain tolerance and postoperative change in WOMAC or VAS pain scores.

This information may help surgeons advise their patients preoperatively and set expectations during the recovery period.

Level of Evidence: Level I: Prognostic study.

This article appears in the HSS Journal: Volume 11, Issue 1.
View the full HSS Journal article at

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


Back in the Game Patient Stories: