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Arthritis Care Res (Hoboken). 2019 Jan 10. doi: 10.1002/acr.23831. [Epub ahead of print]

Factors Associated With Opioid Use in Pre-surgical Knee, Hip and Spine Osteoarthritis Patients.

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Arthritis Program and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Neurosurgery Department of Surgery, University of Toronto, Toronto, Ontario, Canada.



To evaluate rates of prescription opioid use among pre-surgical knee, hip and spine osteoarthritis (OA) patients, and associations between use and socio-demographic and health status characteristics.


Participants were pre-surgical patients with end-stage knee (N=577), hip (N=459) and spine (N=168) OA. Data were collected on current use of opioid and other pain medications, as well as measures of socio-demographics and health status, depression and pain (0-10 numeric rating scale). Rates of opioid use were calculated by sex, age and surgical site. Multivariable logistic regression was used to examine associations between opioid use (outcome: sometimes/daily vs. never) and other study variables.


Participants were of mean age 65.6 years; 55.5% were women. 15% of patients reported 'sometimes' using opioids and 15% reported 'daily' use. Use of opioids was highest among spine OA patients (40%) and similar among knee and hip patients (28% and 30%). Younger women (<65) reported the greatest use of opioid overall, particularly among spine patients. From multivariable logistic regression, greater likelihood of opioid use was significantly associated with spine OA (vs. knee OA), obesity, being a current or former smoker, higher symptomatic joint count, greater depressive symptoms, greater pain and current use of other prescription pain medication.


Nearly a third of pre-surgical OA patients used prescription opioid medication. Given the questionable efficacy of opioids in OA and risk of adverse effects, higher opioid use among younger individuals and those with depressive symptoms is of concern and warrants further investigation. This article is protected by copyright. All rights reserved.


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