Implementation of an opioid weaning program prior to TKR: feasibility and effect on postoperative outcomes

Implementation of an opioid weaning program prior to TKR: feasibility and effect on postoperative outcomes


CIA: Associate Professor Venkatesan Thiruvenkatarajan

Project summary

Total knee replacement (TKR) surgery in Australia has increased from 123 to 242/100,000 population from 2013-2016, with a projected rise of 276 per cent by 2030. Recommendations for medical management of knee osteoarthritis suggest short courses of non-steroidal anti-inflammatory drugs and corticosteroid injections, with strong recommendations against opioid use. A significant increase in opioid prescription for non-cancer related pain has occurred in recent years; one in two Australian patients are prescribed opioids in the year prior to TKR.

A preoperative opioid-free period for up to three months has been associated with reductions in adverse effects, however robust prospective studies exploring the feasibility of opioid weaning before TKR, and its clinical impact are lacking.

The aims of this study are to assess the feasibility of an opioid weaning pathway in patients waiting for TKR, and to assess the impact of preoperative opioid weaning on preoperative pain as well as short-term and long-term postoperative outcome measures.

If opioid weaning is feasible, it will be implemented as standard care across our health network. Patients and the community will benefit by an improvement in their pain, quality of life and reduction in opioid burden. It will guide clinicians to assess the economic impact on healthcare by reducing the risk of post-surgery adverse outcomes.

Supporting patients and their GPs to wean from opioids prior to TKR may both improve pain and functional outcomes and provide a good return on investment.

Chief investigators

Associate Professor Venkatesan Thiruvenkatarajan, Queen Elizabeth Hospital, South Australia
Dr Sarah Flint, Queen Elizabeth Hospital, South Australia
Dr Tim Semple, Queen Elizabeth Hospital, South Australia
Professor Pamela Macintyre, Royal Adelaide Hospital, South Australia


The project was awarded $A59,800 funding through the ANZCA research grants program for 2023.   

Last updated 12:07 8.12.2022