# Association of preoperative chronic opioid use with 1-year revision rate, mortality, and patient-reported outcomes after primary hip and knee arthroplasty: age, sex and BMI matter – a Dutch register-based study

## TL;DR

Chronic opioid use before hip or knee replacement surgery is linked to higher risks of revision, death, and worse outcomes, with effects varying by age, sex, and BMI.

## Contribution

This study identifies how age, sex, and BMI modify the impact of chronic opioid use on surgical outcomes after hip and knee replacements.

## Key findings

- Chronic opioid use doubled mortality and revision rates for both hip and knee surgeries.
- The association with revision risk was stronger in males and specific BMI groups.
- Younger patients had worse physical functioning and quality of life after opioid use.

## Abstract

Our aim was to study the association between chronic preoperative opioid use and 1-year revision rate, mortality, and patient-reported outcomes (PROs) after primary total knee and hip arthroplasty (TKA/THA). We also investigated whether age, sex, or BMI modified these associations.

TKAs and THAs performed for osteoarthritis between 2013 and 2018, originating from the Dutch Arthroplasty Register, were linked to the Dutch Foundation for Pharmaceutical Statistics. Chronic preoperative opioid use was defined as > 1,800 morphine mg equivalent dispensed 1 year before surgery and ≥ 1 opioid prescribed 30 days before surgery. Outcomes were 1-year revision rate, mortality, self-reported physical functioning, pain, and quality of life (QoL). Incidence rates were calculated; Cox regression and linear mixed models were used. We assessed effect modification by assessment of supra-additive effects.

Preoperative chronic opioid use occurred in 4.5% of 29,739 THAs and 3.4% of 27,873 TKAs. Chronic opioid use doubled mortality and revision rates for both TKAs and THAs (range of hazard ratios 1.7–2.1). The association of preoperative opioid use with 1-year revision rate was larger in males, in patients with a BMI ≤ 30 (THA) and > 30 (TKA), and 66–75-year-olds. Younger patients exhibited a more pronounced association between opioid use and reduced physical functioning and QoL, and increased pain. Sex and BMI had no modifying effects on PROs.

Preoperative chronic opioid use was associated with a higher likelihood of 1-year revision and mortality and worse PROs. The associations with revision risk were modified by age, sex, and BMI. Age also had a modifying effect on PROs.