Does Preoperative Opioid Use Increase the Risk of Early Revision Total Hip Arthroplasty?

Background: The purpose of this study is to evaluate the impact of preoperative opioid use on the risk of subsequent revison after primary total hip arthroplasty (THA).

Methods: The Humana database was queried for unilateral THA between 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision THA for 2 years. Factors analyzed included preoperative opioid use (defined as a history of opioid prescription filled within 3 months preceding primary THA), age, sex, diabetes, anxiety/depression, chronic kidney disease, and obesity (body mass index > 30 kg/m). Multivariate logistic regression analysis was used to determine odds ratios.

Results: A total of 17,695 primary THA patients were analyzed and 0.88% (n = 155) underwent revision THA within 2 years. Preoperative opioid use occurred in 36.7% of all. Females comprised 58.7% of the total cohort and 80% were >50 years. Preoperative opioid users were significantly more likely to undergo early THA revision (1.2% vs 0.7%, P < .001). Other patient factors that significantly increased the risk of early THA revision included obesity (1.3% vs 0.8%, P = .03) and a preoperative diagnosis of anxiety/depression (1.9% vs 0.8%, P = .006).

Conclusion: Opioid use within 3 months preceding THA independently predicts an increased risk of early revision. Additionally, independent predictors of early revision include obesity and a diagnosis of anxiety/depression. Factors such as these will need to be considered in risk adjustment models when assessing quality of care or implementing bundled payment initiatives. Further research is needed to evaluate whether discontinuing opioids before surgery mitigates this risk.