Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty

Table 1 List of ICD-9 procedure and complication codes used

ICD-9 code	Procedure and/or complication
81.54	Total knee arthroplasty
81.55; 00.80-00.84	Total knee arthroplasty revision
305.50-305.52	Opioid abuse
304.00-304.02	Opioid dependency
996.41	Mechanical loosening of prosthetic joint
996.42	Dislocation of prosthetic joint
996.43	Broken prosthetic joint implant
996.44	Peri-prosthetic fracture around prosthetic joint
996.47	Other mechanical complication of prosthetic joint implant
996.49	Other mechanical complication of other internal orthopedic device, implant, and graft
996.77	Other complications due to internal joint prosthesis
730, 996.66, 996.67, 996.69, 998.13, 998.30–998.32, 998.51, 998.59	Infection and wound

Table 2 Demographics of patient age and gender undergoing total knee arthroplasty after matching process

Demographics	No. of patients
Age
64 and under	16102
65–69	3616
70–74	1756
75–79	902
80–84	358
85 and over	112
Unknown	226
Gender
Female	15616
Male	7230
Unknown	226

Table 3 Comparison of implant related complications 2-years following primary total knee arthroplasty in opioid abusers and non-opioid abusers

	OUD	NOU	OR	95%CI	P-value
Revision of knee replacement total (all components)	0.42%	0.20%	2.07	1.11–3.84	b
Infection and wound1	6.55%	3.51%	1.92	1.70–2.18	b
Peri-prosthetic fracture around prosthesis	0.72%	0.39%	1.83	1.16–4.79	b
Dislocation of prosthetic joint	2.27%	1.36%	1.68	1.37–2.05	b
Mechanical loosening	1.93%	1.46%	1.33	1.08–1.62	0.006
Broken prosthetic joint implant	0.67%	0.60%	1.11	0.81–1.54	0.509
Other complication due to other internal orthopedic device implant	2.77%	0.99%	2.83	2.28–3.51	b
Other mechanical complication of other internal orthopedic device	3.05%	1.33%	2.33	1.92–2.82	b
Other mechanical complication of prosthetic joint implant	2.46%	1.41%	1.76	1.45–2.13	b
Total	20.84%	11.25%	2.07	1.93–2.23	b

^bP < 0.001;

¹Assessed within 90 d. OUD: Opioid abusers; NUD: Non-opioid abusers; OR: Odds-ratio; 95%CI: 95% Confidence interval.

Table 4 Comparison of day of surgery and total global 90-d episode of care reimbursement amongst opioid abusers and non-opioid abusers undergoing primary total knee arthroplasty within the medicare population

	OUD		NOU
	Day of surgery			P-value
Average reimbursement (SD)	$14499.39 ($10121.95)	$14247.74 ($8827.31)		< 0.001
	90 d cost			P-value
Average reimbursement (SD)	$18619.98 ($14718.50)	$16885.21 ($12184.91)		< 0.001

SD: Standard deviation; OUD: Opioid abusers; NUD: Non-opioid abusers.