Is an Opioid Prescription Necessary after Joint Replacement in 2026?

Background Orthopedic surgeons account for the most perioperative opioid prescriptions among all surgical specialties. Despite the growing emphasis on multimodal analgesia, consistent opioid-free recovery after total joint arthroplasty (TJA) has not been widely demonstrated. Suzetrigine (Journavx™), a peripherally acting sodium-channel inhibitor, represents a novel non-opioid option for postoperative pain. This study evaluated whether adding suzetrigine to a standardized, second-generation multimodal protocol was associated with high rates of opioid-free recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A consecutive series of primary THA and TKA patients performed by a single surgeon were retrospectively reviewed. All patients received suzetrigine 100 mg preoperatively and 50 mg every 12 hours postoperatively for 2 weeks. Preoperative opioid exposure and postoperative opioid prescriptions were documented. Group comparisons were performed using t-tests and chi-square testing and multivariable analysis. Results Overall, 210 of 236 patients (89.0%) did not fill an opioid prescription following surgery. Preoperative opioid use was found in 19 patients (8.1%), and postoperative opioid prescriptions were written for 26 patients (11.0%). TKA patients were more likely to require opioids than THA patients (80.8% vs 19.2%, p = 0.001). Among opioid-naive patients, opioid-free recovery occurred in 88.7% of TKA patients (94/106) and 98.2% of THA patients (109/111). Among patients with preoperative opioid exposure, opioid-free recovery occurred in 30.8% of TKA patients (4/13) and 50.0% of THA patients (3/6) (p < 0.001 for both comparisons). In multivariable analysis, preoperative opioid exposure was independently associated with postoperative opioid use (OR 24.9; 95% CI, 8.5–73.1; p < 0.001). Conclusions In this single-surgeon series, use of suzetrigine to a standardized multimodal protocol was associated with a high rate of opioid-free recovery following THA and TKA. Preoperative opioid use strongly predicted postoperative opioid requirements despite suzetrigine. Prospective multicenter studies are encouraged to further assess these findings and compare other opioid free protocols.