{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:29:53Z","timestamp":1787077793622,"version":"build-2736575974"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Opioid stewardship is a priority after total knee arthroplasty (TKA). Although scheduled, outpatient oxycodone adds clinically meaningful benefit to contemporary multimodal, nonopioid analgesia remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a phase-II, single-center, triple-blind, randomized, placebo-controlled trial. Adults undergoing primary TKA received immediate-release oral oxycodone (5 mg twice daily) or matching placebo for 1 month in addition to a standardized multimodal regimen (acetaminophen, celecoxib, pregabalin). The primary outcome was knee pain on the Visual Analog Scale (VAS) on postoperative days 1, 7, and 30. Secondary outcomes were hospital length of stay, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Pittsburgh Sleep Quality Index (PSQI), patient satisfaction, and adverse events through 6 months. Analyses followed the intention-to-treat principle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Between July 2023 and July 2024, 190 patients were randomized (95 per group); 2 placebo recipients died of myocardial infarction before the 6-month visit. Baseline characteristics were balanced. On postoperative day 1, the mean VAS pain was 6.7 \u00b1 1.5 (mean \u00b1 SD) with oxycodone and 7.2 \u00b1 1.5 with placebo (mean difference, 0.48 cm; 95% confidence intervals, 0.06-0.92; P = 0.015); the difference did not reach the minimal clinically important difference (MCID) (1.0 cm). No between-group differences were observed on day 7 or day 30. Length of stay was reduced by 0.2 days (1.7 vs. 1.9 days, P = 0.047), a statistically significant but clinically modest difference. KOOS, OKS, PSQI, and patient satisfaction were comparable at 1 or 6 months. Minor adverse events were similar between groups; no serious events were attributed to the study drug.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In patients undergoing primary TKA with optimized multimodal, nonopioid analgesia, a fixed 1-month course of oral oxycodone produced small improvements in day 1 pain and length of hospital stay that were statistically significant but below established MCID thresholds. These findings support individualized prescribing through shared decision making rather than routine scheduled oxycodone use after TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00170","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:00:50Z","timestamp":1787076050000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effect of 1-Month Oral Oxycodone on Postoperative Pain Following Total Knee Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"given":"Mohammad","family":"Poursalehian","sequence":"first","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5747-4974","authenticated-orcid":false,"given":"Seyed Hadi","family":"Kalantar","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7964-1163","authenticated-orcid":false,"given":"Mohammadreza","family":"Razzaghof","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4746-7620","authenticated-orcid":false,"given":"Mahboobeh","family":"Tajvidi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5335-3235","authenticated-orcid":false,"given":"Sina","family":"Esmaeili","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maziar","family":"Nafisi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4484-8349","authenticated-orcid":false,"given":"Abdolsalam","family":"Razzaghi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-2718","authenticated-orcid":false,"given":"Mohammad Ali","family":"Mansournia","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirad","family":"Farajidavar","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Hashemipour","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2158-0484","authenticated-orcid":false,"given":"Mohammad Ayati","family":"Firoozabadi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-7777","authenticated-orcid":false,"given":"Seyed Mohammad Javad","family":"Mortazavi","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"11","key":"R1-20260818","doi-asserted-by":"crossref","first-page":"6753","DOI":"10.1007\/s00402-023-04943-6","article-title":"Oxycodone-acetaminophen versus celecoxib for postoperative pain in knee osteoarthritis patients after total knee arthroplasty: a randomized, controlled study","volume":"143","author":"Li","year":"2023","journal-title":"Arch Orthopaedic Trauma Surg"},{"issue":"1_Supple_A","key":"R2-20260818","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1302\/0301-620X.100B1.BJJ-2017-0547.R1","article-title":"Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty","volume":"100-b","author":"Bedard","year":"2018","journal-title":"Bone Joint J"},{"issue":"7","key":"R3-20260818","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.1016\/j.arth.2021.02.044","article-title":"Early postoperative pain after total knee arthroplasty is associated with subsequent poorer functional outcomes and lower satisfaction","volume":"36","author":"Lo","year":"2021","journal-title":"J Arthroplasty"},{"issue":"2S","key":"R4-20260818","doi-asserted-by":"crossref","first-page":"SE33","DOI":"10.36076\/ppj.2017.sE52","article-title":"Oral oxycodone for acute postoperative pain: a review of clinical trials","volume":"20","author":"Cheung","year":"2017","journal-title":"Pain Physician"},{"key":"R5-20260818","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.artd.2020.12.021","article-title":"Postdischarge opioid use after total hip and total knee arthroplasty","volume":"7","author":"Atwood","year":"2021","journal-title":"Arthroplasty Today"},{"issue":"10","key":"R7-20260818","doi-asserted-by":"crossref","first-page":"2715","DOI":"10.1016\/j.arth.2020.05.037","article-title":"The efficacy and safety of acetaminophen in total joint arthroplasty: systematic review and direct meta-analysis","volume":"35","author":"Fillingham","year":"2020","journal-title":"J Arthroplasty"},{"issue":"7","key":"R8-20260818","doi-asserted-by":"crossref","first-page":"e616","DOI":"10.3928\/01477447-20150701-61","article-title":"Multimodal analgesia for total joint arthroplasty","volume":"38","author":"Halawi","year":"2015","journal-title":"Orthopedics"},{"key":"R9-20260818","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijsu.2016.05.036","article-title":"Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: a meta-analysis","volume":"31","author":"Kuang","year":"2016","journal-title":"Int J Surg"},{"issue":"1","key":"R10-20260818","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.arth.2017.07.024","article-title":"Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial","volume":"33","author":"Mont","year":"2018","journal-title":"J Arthroplasty"},{"issue":"1","key":"R11-20260818","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s11999.0000000000000292","article-title":"The 2018 chitranjan S. Ranawat, MD award: developing and implementing a novel institutional guideline strategy reduced postoperative opioid prescribing after TKA and THA","volume":"477","author":"Wyles","year":"2019","journal-title":"Clin Orthopaedics Relat Res"},{"issue":"7","key":"R12-20260818","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.arth.2019.01.065","article-title":"The James A. Rand Young Investigator's Award: large opioid prescriptions are unnecessary after total joint arthroplasty: a randomized controlled trial","volume":"34","author":"Hannon","year":"2019","journal-title":"J Arthroplasty"},{"issue":"4","key":"R13-20260818","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s10787-021-00828-5","article-title":"Oxycodone\u2013paracetamol tablet exhibits increased analgesic efficacy for acute postoperative pain, higher satisfaction and comparable safety profiles compared with celecoxib in patients underwent arthroscopic knee surgery","volume":"29","author":"Liu","year":"2021","journal-title":"Inflammopharmacology"},{"issue":"4","key":"R14-20260818","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.OA.22.00074","article-title":"Comparison of the effect of intra-articular, periarticular, and combined injection of analgesic on pain following total knee arthroplasty: a double-blinded randomized clinical trial","volume":"7","author":"Mortazavi","year":"2022","journal-title":"JBJS Open Access"},{"issue":"5","key":"R15-20260818","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.bja.2021.01.021","article-title":"Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: a systematic review","volume":"126","author":"Laigaard","year":"2021","journal-title":"Br J Anaesth"},{"issue":"8","key":"R16-20260818","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s00167-013-2776-5","article-title":"The minimal clinically important difference in the Oxford knee score and short form 12 score after total knee arthroplasty","volume":"22","author":"Clement","year":"2014","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"9","key":"R17-20260818","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2106\/JBJS.23.00027","article-title":"Diagnosis-specific thresholds of the minimal clinically important difference and patient acceptable symptom state for KOOS after total knee arthroplasty","volume":"106","author":"Emara","year":"2024","journal-title":"J Bone Joint Surg"},{"issue":"16","key":"R18-20260818","doi-asserted-by":"crossref","first-page":"8666","DOI":"10.3390\/ijerph18168666","article-title":"Minimal clinically important difference and patient acceptable symptom state for the Pittsburgh sleep quality index in patients who underwent rotator cuff tear repair","volume":"18","author":"Longo","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"13","key":"R19-20260818","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1055\/a-1911-3892","article-title":"30-Days to 10-Years mortality rates following total knee arthroplasty: a systematic review and meta-analysis of the last decade (2011-2021)","volume":"36","author":"Pan","year":"2023","journal-title":"J Knee Surg"},{"issue":"4","key":"R20-20260818","first-page":"277","article-title":"Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement","volume":"48","author":"de Beer","year":"2005","journal-title":"Can J Surg"},{"issue":"11","key":"R21-20260818","doi-asserted-by":"crossref","first-page":"e2134988","DOI":"10.1001\/jamanetworkopen.2021.34988","article-title":"Effectiveness of oxycodone hydrochloride (strong opioid) vs combination acetaminophen and codeine (mild opioid) for subacute pain after fractures managed surgically: a randomized clinical trial","volume":"4","author":"Jenkin","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"10180","key":"R22-20260818","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1016\/S0140-6736(19)30430-1","article-title":"Perioperative opioid analgesia\u2014when is enough too much? A review of opioid-induced tolerance and hyperalgesia","volume":"393","author":"Colvin","year":"2019","journal-title":"Lancet"},{"issue":"5","key":"R23-20260818","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/os.12535","article-title":"Postoperative pain management in total knee arthroplasty","volume":"11","author":"Li","year":"2019","journal-title":"Orthopaedic Surg"},{"issue":"11","key":"R24-20260818","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.2106\/JBJS.J.01095","article-title":"Multimodal pain management after total joint arthroplasty","volume":"93","author":"Parvizi","year":"2011","journal-title":"J Bone Joint Surg"},{"issue":"1","key":"R25-20260818","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.2106\/JBJS.OA.22.00062","article-title":"Opioid-sparing multimodal analgesia efficacy in hispanic patients undergoing total knee arthroplasty","volume":"8","author":"Olivella","year":"2023","journal-title":"JBJS Open Access"},{"issue":"8","key":"R26-20260818","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1016\/j.arth.2024.01.063","article-title":"Opioid consumption after discharge from total knee and hip arthroplasty: a systematic review and meta-analysis","volume":"39","author":"Dawson","year":"2024","journal-title":"J Arthroplasty"},{"issue":"1","key":"R27-20260818","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.arth.2020.07.032","article-title":"Reduction of opioids prescribed upon discharge after total knee arthroplasty significantly reduces consumption: a prospective study comparing two states","volume":"36","author":"Chalmers","year":"2021","journal-title":"J Arthroplasty"},{"issue":"12","key":"R28-20260818","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1016\/j.arth.2019.06.055","article-title":"Anesthesia and analgesia practices in total joint arthroplasty: a survey of the American Association of hip and knee surgeons membership","volume":"34","author":"Hannon","year":"2019","journal-title":"J Arthroplasty"},{"issue":"6","key":"R29-20260818","doi-asserted-by":"crossref","first-page":"e170504","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg"},{"issue":"2","key":"R30-20260818","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/SLA.0000000000002308","article-title":"Probability of opioid prescription refilling after surgery: does initial prescription dose matter?","volume":"268","author":"Sekhri","year":"2018","journal-title":"Ann Surg"},{"issue":"1","key":"R31-20260818","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/17453674.2019.1683790","article-title":"Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS((R))) society recommendations","volume":"91","author":"Wainwright","year":"2020","journal-title":"Acta Orthopaedica"},{"issue":"5","key":"R32-20260818","first-page":"212","article-title":"Reduction of opioid use with enhanced recovery program for total knee arthroplasty","volume":"38","author":"Collett","year":"2021","journal-title":"Fed Pract"},{"issue":"2","key":"R33-20260818","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.arth.2013.06.005","article-title":"Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial","volume":"29","author":"Lamplot","year":"2014","journal-title":"J Arthroplasty"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:01:04Z","timestamp":1787076064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00170","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}