Patient-reported Outcomes Associated With Preoperative Opioid Use in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study

Background: Opioid use is a public health crisis in the United States and an area of increased focus within the arthroplasty literature. The aim of this study was to investigate the effect of preoperative opioid use on patient-reported outcome measures (PROMs) before and after revision total hip arthroplasty (THA). Methods: A total of 381 consecutive revision THA patients with both preoperative and postoperative PROMs were identified. Because of differences in baseline characteristics, 104 opioid users were matched to 208 nonusers using nearest-neighbor propensity score matching. Results: Propensity score-matched opioid users had significantly lower preoperative PROMs than the nonuser for hip disability and osteoarthritis outcome score physical function (53.2 versus 60.1, P < 0.01) and patient-reported outcomes measurement information system (PROMIS) short form (SF) Physical (38.5 versus 43.2, P < 0.01). Postoperatively, opioid users demonstrated significantly lower scores across all PROMs: hip disability and osteoarthritis outcome score physical function (58.1 versus 70.0, P < 0.001), PROMIS SF Physical (40.3 versus 48.4, P < 0.001), and PROMIS SF Mental (43.7 versus 53.2, P < 0.001). Propensity score-matched opioid users demonstrated an increased hospital stay (P = 0.04). Discussion: Revision THA patients who use opioids preoperatively have notably lower preoperative and postoperative outcome scores compared with propensity score-matched nonusers. As opioid use has the potential to be a modifiable factor, it would be important to counsel patients on the benefit of minimizing or eliminating opioid use preoperatively to optimize outcome after revision THA.