Surgical Approach Does Not Affect Chronic Opioid Usage After Total Hip Arthroplasty

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Total hip arthroplasty (THA) utilizes direct anterior, antero-lateral, and posterior surgical approaches.
• The direct anterior approach is theorized to reduce postoperative pain and opioid use.
• Perioperative opioid consumption is a risk factor for long-term opioid dependence.

Purpose of the Study:

• To investigate if the direct anterior approach for THA is associated with reduced opioid usage within 180 days compared to antero-lateral or posterior approaches.
• To evaluate the association between THA surgical approach and long-term opioid use.

Main Methods:

• Retrospective cohort study of 508 patients undergoing THA.
• Opioid use assessed 90 days pre-surgery and 1 year post-surgery using state prescription data.
• Regression analyses controlled for patient demographics and surgical characteristics to assess the impact of surgical approach on opioid use.

Main Results:

• No significant difference in long-term opioid use or prescription fills was observed among the three surgical approaches (P = .78 and P = .35, respectively).
• Pre-operative opioid non-use was strongly associated with a 78% decrease in the odds of becoming a chronic opioid user post-THA (P < .0001).

Conclusions:

• Pre-operative opioid use, rather than the specific THA surgical approach, is the primary predictor of chronic opioid consumption after total hip arthroplasty.
• Screening for and managing pre-existing opioid use may be crucial for mitigating long-term opioid dependence following THA.