Postoperative opioid use as an early indication of total hip arthroplasty failure

Robert S. Namba, Maria C.S. Inacio, Nicole L. Pratt, Stephen E. Graves, Elizabeth E. Roughead, T. Craig Cheetham, Elizabeth W. Paxton

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Background and purpose — A criticism of total hip arthroplasty (THA) survivorship analysis is that revisions are a late and rare outcome. We investigated whether prolonged opioid use is a possible indicator of early THA failure. Patients and methods — We conducted a cohort study of THAs registered in a total joint replacement registry from January 2008 to December 2011. 12,859 patients were evaluated. The median age was 67 years and 58% were women. Opioid use in the year after surgery was the exposure of interest, and the cumulative daily amounts of oral morphine equivalents (OMEs) were calculated. Post-THA OMEs per 90 day periods were categorized into quartiles. The endpoints were 1- and 5-year revisions. Results — After the first 90 days, 27% continued to use opioids. The revision rate was 0.9% within a year and 1.7% within 5 years. Use of medium-low (100–219 mg), medium-high (220–533 mg), and high (≥ 534 mg) amounts of OMEs in days 91–180 after surgery was associated with a 6 times (95% confidence interval (CI): 3–15), 5 times (CI: 2–13), and 11 times (CI: 2.9–44) higher adjusted risk of 1 year revision, respectively. The use of medium-low and medium-high amounts of OMEs in days 181–270 after surgery was associated with a 17 times (CI: 6–44) and 14 times (95% CI: 4–46) higher adjusted risk of 1-year revision. There was a similar higher risk of 5-year revision. Interpretation — Persistent postoperative use of opioids was associated with revision THA surgery in this cohort, and it may be an early indicator of potential surgical failures.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalActa Orthopaedica
Publication statusPublished - 15 Jun 2016

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Namba, R. S., Inacio, M. C. S., Pratt, N. L., Graves, S. E., Roughead, E. E., Craig Cheetham, T., & Paxton, E. W. (2016). Postoperative opioid use as an early indication of total hip arthroplasty failure. Acta Orthopaedica, 87, 37-43.