Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees

Osteoarthritis Cartilage. 2019 Oct;27(10):1445-1453. doi: 10.1016/j.joca.2019.05.023. Epub 2019 Jun 26.


Objective: To examine patterns of prescription opioid use before total joint replacement (TJR) and factors associated with continuous use of opioids before TJR.

Design: We conducted an observational cohort study among Medicare enrollees aged ≥65 years who underwent TJR between 2010 and 2014. Preoperative opioid use was defined as having any opioid prescription in the 12-month period before TJR. Patients who had an opioid prescription every month for a 12-month period were defined as continuous users. We examined patients' demographics, pain-related conditions, medication use, other comorbidities, healthcare utilization and their association with use of opioids before TJR.

Results: A total of 473,781 patients underwent TJR:,155,516 THR and 318,265 TKR. Among the total cohort, 60.2% patients had any use of opioids and of those, 12.4% used opioids at least once a month continuously over the 12-month baseline period. Correlates of continuous opioid use included African American race (OR = 2.14, 95% confidence intervals (CI) = 2.01-2.28, compared to White patients), history of drug abuse (OR = 5.18, 95% CI = 3.95-6.79) and back pain (OR = 2.32, 95% CI = 2.24-2.39).

Conclusions: In this large cohort of patients undergoing TJR, over 60% ever used opioids and 12.4% of them continuously used opioids in the 12-month prior to surgery. Utilization of opioids became more frequent and high-dosed near the surgery. History of drug abuse, back pain, and African American race were strongly associated with continuous use of opioids preoperatively. Further research is needed to determine short-term and long-term risks of preoperative use of opioids in TJR patients and to optimize pre- and post-TJR pain management of patients with arthritis.

Keywords: Opioids; Osteoarthritis; Total joint replacement.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use*
  • Arthralgia / drug therapy*
  • Arthralgia / etiology*
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Cohort Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Medicare
  • Osteoarthritis, Hip / complications*
  • Osteoarthritis, Hip / surgery*
  • Osteoarthritis, Knee / complications*
  • Osteoarthritis, Knee / surgery*
  • Preoperative Care / methods*
  • United States


  • Analgesics, Opioid