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

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.