Association of preoperative psychopharmacological treatment and the risk of new chronic opioid use after hip and knee arthroplasty: a Danish registry-based cohort study of 73,033 procedures

Background and purpose — Chronic opioid use is of great concern worldwide. Thus, identification of risk factors for new chronic opioid use (COU) after hip and knee arthroplasty is imperative to target preventive strategies. Depression/anxiety may be risk factors for new COU. However, no studies have investigated whether any or subgroups of preoperative psychopharmacological treatments (PPTs) are risk factors for new COU after hip and knee arthroplasty in a nationwide setting, which was the aim of the present study. Methods — This population-based cohort study included 40,476 primary hip and 32,557 primary knee arthroplasties from 2015 to 2022 using the Danish Hip/Knee Arthroplasty Registers. Preoperative opioid users were excluded. Dispensing records of psychotropics and opioids were obtained from the Danish National Prescription Registry. Relative risks of new COU were estimated with 95% confidence intervals (CI) using binary regression and adjusted for age, sex, and Charlson Comorbidity Index. Results — Among hip patients using psychopharmacological treatments (PPTs), 4.6% (202/4,439) had new COU compared with 2.2% (788/36,037) of patients not using PPTs, corresponding to an adjusted relative risk of 1.8 (CI 1.6–2.1). Among total and unicompartmental knee arthroplasties, 9.1% (298/3,261) and 6.4% (59/926) had new COU compared with 4.7 (1,011/21,529) and 2.9% (201/6,841) of patients not using PPTs, corresponding to adjusted relative risks of 1.8 (CI 1.6–2.1) and 2.0 (CI 1.5–2.7), respectively. Analyses of PPT subgroups showed similar results. Conclusion — Hip and knee arthroplasty patients using PPTs have almost a twofold increased risk of new COU. This emphasizes the need for prevention strategies in these patients.