Preoperative chronic opiate use associated with a worse joint-specific function and quality of life before and after total hip and knee arthroplasty.

Abstract

The aim of this study was to assess whether chronic pre-arthroplasty use of strong opiates impacted the pre- and postoperative joint-specific function, quality of life (QoL), pain scores, and satisfaction in those undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This prospective study assessed 1,487 patients (THA n = 729; TKA n = 758). Preoperative opiate use of more than a month was used to define the opioid group. Patient demographics, comorbidities, Oxford Hip Score (OHS), Oxford Knee Score (OKS), and EuroQol five-dimension questionnaire (EQ-5D) scores were collected preoperatively and at six months postoperatively. Patient satisfaction with their joint was assessed at six months. The opioid groups consisted of 95 patients in both the THA (13.0%) and TKA (12.5%) cohorts. Pre- and postoperative OHS, OKS, and EQ-5D were clinically (greater than the minimal clinically important difference) and statistically (p < 0.001) significantly worse for the opioid groups undergoing THA and TKA. The opioid group was independently associated with a significantly worse improvement in OHS (-3.0, 95% CI -4.8 to -1.2; p = 0.001) and EQ-5D (-0.089, 95% CI -0.132 to -0.041; p < 0.001) for those undergoing THA, but no significant (OKS, p = 0.650 and EQ-5D, p = 0.485) association was demonstrated in the TKA cohort. There was no difference in satisfaction with their arthroplasty between opioid and opiate-naive groups undergoing THA (p = 0.133) or TKA (p = 0.797). Preoperative opiate use was associated with clinically significantly worse pre- and postoperative joint-specific function and QoL. Those undergoing THA had a clinically worse improvement in their joint-specific function, but this was not observed in those undergoing TKA. However, patients were equally satisfied with outcomes.