Top

Published in:

Open Access 01-12-2016 | Research article

Opioid use after total hip arthroplasty surgery is associated with revision surgery

Authors: Maria C. S. Inacio, MS, PhD, Nicole L. Pratt, PhD, Elizabeth E. Roughead, PhD, Elizabeth W. Paxton, MA, Stephen E. Graves, MD, PhD

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Abstract

Background

Pain is an indication for total hip arthroplasty (THA) and it should be resolved post-surgery. Because patients’ pain is typically treated pharmacologically we tested whether opioid use can be used as a surrogate for patient-reported pain and as an indicator for early surgical failure. Specifically, we evaluated whether the amount of opioids taken within the year after THA was associated with one and five years risk of revision surgery.

Methods

A cohort of 9943 THAs (01/2001-12/2012) was evaluated. Post-operative opioid use was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total OMEs/90-day periods were categorised into quartiles. Revisions within one and five years were the outcomes of interest.

Results

Of the THAs, 2.0 % (N = 200) were revised within one year and 4.2 % (N = 413) within five years. After adjustments for gender, age, surgical indication, co-morbidities, and other analgesics, revision was associated with amount of OMEs in the second quarter after THA (days 91–180 after discharge). Patients on medium-high amounts of OME (400-1119 mg) had higher risk of one (hazard ratio (HR) = 2.22, 95 % CI 1.08-4.56) and five year (HR = 1.66, 95 % CI 1.08-2.56) revision than a patient not taking opioids. During the same period, patients taking the highest amounts of OMEs (≥1120 mg) had a 2.64 (95 % CI 1.03-6.74) times higher risk of one year and a 2.11 (95 % CI 1.13-3.96) times higher risk of five year revision.

Conclusions

Opioid use 91–180 days post-surgery is associated with higher risk of revision surgery and therefore is an early and useful indicator for surgical failure.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137–62. doi:10.1016/j.joca.2007.12.013.CrossRefPubMed

Alviar MJ, Olver J, Brand C, Tropea J, Hale T, Pirpiris M, et al. Do patient-reported outcome measures in hip and knee arthroplasty rehabilitation have robust measurement attributes? A systematic review. J Rehabil Med. 2011;43(7):572–83. doi:10.2340/16501977-0828.CrossRefPubMed

Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435. doi:10.1136/bmjopen-2011-000435.CrossRefPubMedPubMedCentral

Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Bohler N, Labek G. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty. 2013;28(8):1329–32. doi:10.1016/j.arth.2013.01.012.CrossRefPubMed

Rothwell AG, Hooper GJ, Hobbs A, Frampton CM. An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br. 2010;92(3):413–8. doi:10.1302/0301-620X.92B3.22913.CrossRefPubMed

Ekman EF, Koman LA. Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management. Instr Course Lect. 2005;54:21–33.PubMed

Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167. doi:10.1136/bmj.f167.CrossRefPubMed

Bergman S. Management of musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;21(1):153–66. doi:10.1016/j.berh.2006.10.001.CrossRefPubMed

Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–74.CrossRef

10.

Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287–313. doi:10.1111/j.1533-2500.2008.00204.x.CrossRefPubMed

11.

WHO. Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment. 2014. Oslo, Norway: 2013.

12.

Health AGDo. Australian Goverment Department of Health. Pharmaceutical Benefits Services. 2014. http://www.pbs.gov.au/browse/medicine-listing. Accessed March 1st, 2014.

13.

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). National Centre for Classification in Health. 2013. https://www.accd.net.au/Icd10.aspx. Accessed February 2014.

14.

Australian and New Zealand College of Anaesthetist FoPM. Opioid Conversion to oral Morphine Equivalent Daily Dose (oMEDD). In: Toolkit for estimate of oMEDD only. 2014. http://www.fpm.anzca.edu.au/resources/professional-documents/OPIOID%20DOSE%20EQUIVALENCE.pdf. Accessed September 7, 2015.

15.

Fishman PA, Goodman MJ, Hornbrook MC, Meenan RT, Bachman DJ, O'Keeffe Rosetti MC. Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003;41(1):84–99. doi:10.1097/01.MLR.0000039830.19812.29.CrossRefPubMed

16.

Staibano P, Winemaker M, Petruccelli D, de Beer J. Total joint arthroplasty and preoperative low back pain. J Arthroplasty. 2014;29(5):867–71. doi:10.1016/j.arth.2013.10.001.CrossRefPubMed

17.

Walker BF, Muller R, Grant WD. Low back pain in Australian adults: the economic burden. Asia-Pacific J Public Health. 2003;15(2):79–87.CrossRef

18.

Britton AR, Murray DW, Bulstrode CJ, McPherson K, Denham RA. Pain levels after total hip replacement: their use as endpoints for survival analysis. J Bone Joint Surg Br. 1997;79(1):93–8.CrossRefPubMed

19.

Singh JA, Lewallen D. Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord. 2010;11:90. doi:10.1186/1471-2474-11-90.CrossRefPubMedPubMedCentral

20.

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25. doi:10.1016/S0140-6736(06)68700-X.CrossRefPubMed

21.

Pivec R, Issa K, Naziri Q, Kapadia BH, Bonutti PM, Mont MA. Opioid use prior to total hip arthroplasty leads to worse clinical outcomes. Int Orthop. 2014;38(6):1159–65. doi:10.1007/s00264-014-2298-x.CrossRefPubMedPubMedCentral

22.

Strom BL. Overview of Automated Databases in Pharmacoepidemiology, in Pharmacoepidemiology. 5th ed. Wiley-Blackwell: Oxford, UK; 2012.

23.

Wettermark B, Zoega H, Furu K, Korhonen M, Hallas J, Norgaard M, et al. The Nordic prescription databases as a resource for pharmacoepidemiological research--a literature review. Pharmacoepidemiol Drug Saf. 2013;22(7):691–9. doi:10.1002/pds.3457.CrossRefPubMed

24.

Australian Government Department of Health. Pharmaceutical Benefits Scheme (PBS). 2014. http://www.pbs.gov.au/pbs/home. Accessed June 24 2014.

25.

Medicare.gov - the Official U.S. Government Site for Medicare. Drug coverage (Part D). 2014. http://www.medicare.gov/part-d/. Accessed July 9th 2014.

26.

Lyman S, Dunn WR, Spock C, Bach PB, Mandl LA, Marx RG. Validity of same-side reoperation after total hip and knee arthroplasty using administrative databases. J Knee Surg. 2009;22(1):17–20.CrossRefPubMed

27.

Singh JA, Kundukulam JA, Bhandari M. A systematic review of validated methods for identifying orthopedic implant removal and revision using administrative data. Pharmacoepidemiol Drug Saf. 2012;21 Suppl 1:265–73. doi:10.1002/pds.2309.CrossRefPubMed

28.

Wu AW, Snyder C, Clancy CM, Steinwachs DM. Adding the patient perspective to comparative effectiveness research. Health Aff. 2010;29(10):1863–71. doi:10.1377/hlthaff.2010.0660.CrossRef

Title: Opioid use after total hip arthroplasty surgery is associated with revision surgery
Authors: Maria C. S. Inacio, MS, PhD
Nicole L. Pratt, PhD
Elizabeth E. Roughead, PhD
Elizabeth W. Paxton, MA
Stephen E. Graves, MD, PhD
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-016-0970-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Opioid use after total hip arthroplasty surgery is associated with revision surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia Intervention for Managing patient Experience (MIME). Study protocol for a cluster randomised crossover trial

Factors associated with diagnostic stage of hip osteoarthritis due to acetabular dysplasia among Japanese female patients: a cross-sectional study

EGR1 controls divergent cellular responses of distinctive nucleus pulposus cell types

Associations of LBX1 gene and adolescent idiopathic scoliosis susceptibility: a meta-analysis based on 34,626 subjects

Clinical trial and in-vitro study comparing the efficacy of treating bony lesions with allografts versus synthetic or highly-processed xenogeneic bone grafts

Determinants of patient satisfaction and their willingness to return after primary total hip replacement: a cross-sectional study