Physical Therapy Before and After TKA Linked to Lower Odds for Long-Term Opioid Use

physical therapy
physical therapy
Physical therapy prior to and after total knee replacement may reduce long-term opioid use after surgery

Physical therapy prior to and after total knee replacement (TKR) may reduce long-term opioid use after surgery, according to a study in JAMA Network Open.

The study was an analysis of 67,322 patients (mean age, 66.2 years) who underwent TKR between January 2001 and December 2016, stratified by opioid use history, who were included in the Optum Labs Data Warehouse.

Researchers evaluated the association of pre- and post-TKR physical therapy with the risk of long-term opioid use that occurred >90 days following TKR. These associations were assessed in a logistic regression analysis adjusted for age, sex, race and ethnicity, obesity, type of insurance, geographical location, and physical and mental health comorbidities.

In the overall cohort, 38,408 patients were opioid naïve (mean age, 66.2 years) and 28,914 patients were opioid experienced (mean age, 64.4 years). Patients who received any physical therapy prior to TKR had lower odds of long-term opioid use in patients who were opioid naive (adjusted odds ratio [aOR], 0.75; 95% CI, 0.60-0.95) as well as those who were opioid experienced (aOR, 0.75; 95% CI, 0.70-0.80).

Additionally, the receipt of any physical therapy after TKR was significantly associated with lower odds of long-term opioid use in opioid-experienced patients (aOR, 0.75; 95% CI, 0.70-0.79). In the opioid-experienced patients, a total of 6 to 12 physical therapy sessions (aOR, 0.82; 95% CI, 0.75-0.90) and ≥13 sessions (aOR, 0.71; 95% CI, 0.65-0.77) were associated with lower odds of long-term opioid use compared with 1 to 5 sessions of postoperative physical therapy.

In opioid-naïve patients, the initiation of physical therapy 31 to 60 days after TKR (aOR, 1.45; 95% CI, 1.19-1.77) or 61 to 90 days after TKR (aOR, 2.15; 95% CI, 1.43-3.22) was associated with greater odds of long-term opioid use. Similar findings were reported in the opioid-experienced cohort (31-60 days: aOR, 1.10, 95% CI, 1.02-1.18; 61-90 days: aOR, 1.32, 95% CI, 1.12-1.55).

When compared with passive physical therapy, active physical therapy was not significantly associated with long-term opioid use in the opioid-naive (aOR, 1.00; 95% CI, 0.81-1.24) or opioid-experienced (aOR, 0.99; 95% CI, 0.92-1.07) patients.

The study investigators concluded that the “assessment of long-term opioid use after TKR may be a pertinent end point to consider in recommendations regarding physical therapy interventions before and after TKR.”

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Aoyagi K, Neogi T, Peloquin C, et al. Association of physical therapy interventions with long-term opioid use after total knee replacement. JAMA Netw Open. 2021;4(10):e2131271. doi:10.1001/jamanetworkopen.2021.31271