Toward Opioid-Free Total Hip Arthroplasty: A Retrospective Study of a Targeted Opioid Reduction Program in 229 Patients.

BACKGROUND

Prescription opioids leftover following arthroplasty surgery pose risks to patients and communitys. The purpose of this study was to capture opioid utilization patterns following primary total hip arthroplasty before and after a targeted intervention to decrease postoperative opioid prescription quantity. We hypothesized that reducing discharge pill count would not impact pain or functional outcomes.

METHODS

Primary total hip arthroplasties performed by a high-volume, fellowship-trained arthroplasty surgeon between October 2022 and January 2024 were retrospectively evaluated for study inclusion; 229 patients met inclusion criteria. Beginning in April 2023, the surgeon gradually implemented a 38% reduction in postoperative opioid prescribing from 40 to 24 pills. Opioid consumption was evaluated by patient-reported pill count at the first postoperative visit. Patients were sorted into 2 groups: "preintervention" (n = 157) and "postintervention" (poI) (n = 72). Preintervention patients received between 300 and 420 oral morphine equivalents and poI patients received between 240 and 299.99 oral morphine equivalents. Demographics, pill counts, refills, 30-day emergency department visits, function (Hip Disability and Osteoarthritis Outcome Score Joint Replacement), pain (visual analog scale), and satisfaction scores were analyzed.

RESULTS

Proportion of discharge prescription remaining at 2-week postoperative visit did not differ significantly between intervention groups ( = .33). There were no differences in opioid refill requests ( = .82), function ( = .75), or satisfaction with functional improvement ( = .61). Patients in the poI group reported lower pain at 6 weeks postoperatively ( < .05). There were no differences in 30-day emergency department visits between groups ( = .57).

CONCLUSIONS

Results support that arthroplasty surgeons can prescribe smaller quantities of opioids without compromising care. Such interventions can help reduce the number of prescription opioids available for misuse and diversion.