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e adjustment of the soft tissue balance during TKA. Level II. Level II. Adequate postoperative pain control following total knee arthroplasty (TKA) is required to achieve optimal patient recovery. However, the postoperative recovery may lead to an unnaturally extended opioid use, which has been associated with adverse outcomes. This study hypothesizes that machine learning models can accurately predict extended opioid use following primary TKA. A total of 8873 consecutive patients that underwent primary TKA were evaluated, including 643