Robotic-Assisted Primary Total Knee Arthroplasty is Associated With Decreased 90-Day Opioid Prescribing Patterns Compared to Manual Instrumentation

Background Robotic assistance minimizes bony resection and surrounding soft tissue damage during total knee arthroplasty (TKA), potentially decreasing postoperative pain. The objective of this study was to evaluate in-hospital opioid consumption, 90-day opioid prescribing patterns, length of stay (LOS), and patient-reported outcome measures (PROMs) following robotic-assisted vs manual primary TKA. Methods Utilizing an institutional database, all patients undergoing primary unilateral TKA between 2019 and 2022 with 90-day minimum follow-up were retrospectively queried. Patients were excluded if they had another surgery within 90 days of the index TKA, were discharged to a rehabilitation center, or were prescribed opioid or benzodiazepine medications preoperatively. One-to-one propensity score matching identified 1476 patients undergoing robotic-assisted (n = 738) or manual (n = 738) TKA. Multivariable regression analysis assessed in-hospital morphine milligram equivalents (MMEs) consumption, LOS, 90-day opioid prescribing patterns (not necessarily consumption), and PROMs (preoperative, 6 weeks, and 3 months). Results The robotic-assisted cohort consumed on average 12 fewer in-hospital MMEs ( P = .026) and had an average LOS that was 8 hours shorter than the manual cohort ( P < .001). There was no difference in MMEs prescribed at discharge ( P = .12), but the robotic-assisted cohort had on average 113 fewer 90-day postdischarge MMEs prescribed ( P = .001) and 145 fewer total 90-day MMEs (consumed in-hospital plus prescribed) ( P < .001). There was no difference in PROMs at 6 weeks or 3 months. Conclusions Robotic-assisted TKA may confer shorter LOS with decreased 90-day opioid use patterns. This information is important given the increased scrutiny on opioid usage and recent focus on rapid recovery and ambulatory TKA pathways.