Older patients who were still taking opioids (morphine equivalents) three months after having received a total hip arthroplasty (THA) were more likely to need revision surgery at one year and five years than did those who stopped their opioid use after 90 days.
Opioid Use Following THA Linked to Revisions
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That is the result of a study conducted by Maria C.S. Inacio, Ph.D., of the University of South Australia, Adelaide, and her colleagues who evaluated 9, 943 THAs performed on Australian patients from 2001 to 2012. The mean age of the patients was 81.1 years. About 80% of the cohort had a diagnosis of primary coxarthrosis. About 2% had a revision within one year and 4.2% underwent a revision within five years.
The researchers found that among those patients who used 400 to 1, 119 mg of opioids in the second 90-day period after undergoing THA adjustment, revision was more than twice as likely at one year and nearly twice as likely at five years than it was among the non-users.
The researchers interpreted their findings “not as causal but rather as a reflection of persistent pain.” In other words, patients were still experiencing pain because of something that took place during the surgical procedure or conditions relating to their underlying illness.
Wayne Kuznar, contributing reporter for MedPage Today, reported that researchers also found that patients who had a revision within one year used more postoperative nonsteroidal anti-inflammatory drugs (NSAID) in each quarter after surgery (range 38.5%-50.0%) compared with patients not having a revision (range 29.7%-40.3%). Before the THA, however, the proportion of NSAID users was similar in both groups.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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