Trajectories of Opioid Use Following Revision Total Hip Arthroplasty: A Population-Based Cohort Study.

Abstract

Patients undergoing revision total hip arthroplasty (THA) are at higher risk of persistent opioid use postoperatively compared to those undergoing primary THA, raising safety concerns due to associated serious adverse effects. However, limited knowledge exists on how opioid use changes over time following revision THA and which patients are at risk of persistent use. This study aimed to identify distinct trajectories of opioid use in the first 2 years following revision THA and describe characteristics for trajectory group membership. This population-based cohort study included 12,314 patients who underwent first revision THA between 1995 and 2019, as documented in the Danish Hip Arthroplasty Registry. Group-based trajectory models were used to describe the average daily morphine milligram equivalent (MME) value of opioid prescriptions redeemed per quarter (Q) in the 2 years following revision THA. The MME data and opioid use information were derived from the Danish National Prescription Registry. In addition, the prevalence of patients redeeming at least one opioid prescription per quarter was calculated. Logistic regression models were applied to estimate crude risk ratios for the association between clinical characteristics and trajectory group membership. Opioid use decreased from 74% in the first quarter to 26% in the fifth quarter through eighth quarter. There were three distinct trajectory groups identified: minimal use (76% - mean MME/day at the first quarter = 5.7, eighth quarter = 0.7), steady use (18% - mean MME/day at the first quarter = 30.4, eighth quarter = 23.8), and high use (6% - mean MME/day at the first quarter = 101.1, eighth quarter = 111.4). Patients in the steady and high use groups had poorer health and social status than patients in the minimal use group. At 2 years after revision THA, 26% of patients were opioid users, raising concern about potentially related serious adverse events. The findings underscore the need for personalized perioperative pain management strategies to reduce persistent opioid use.