Opioid legislation and narcotic filling in total hip arthroplasty: descriptive study of time and state-level trends in the United States.

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The opioid misuse epidemic focused national attention on reducing opioid overprescribing. The purpose of this study is to describe the relationship of time and state-level interventions and opioid filling surrounding total hip arthroplasty (THA) in the United States.


A national database with diverse insurance constituents was queried for first-prescription and cumulative perioperative opioid filling volumes and rates in oxycodone 5-mg equivalents (OE's) in 487,942 patients undergoing primary THA from 30-days pre-operative to 90-days post-operative. Descriptive statistics evaluated pre-legislative and post-legislative opioid filling by state, legislative type, and surgery year.


At the national level, initial opioid filling volumes have remained largely unchanged (56.2 OE's in 2010 to 51.7 OE's in 2018). Meanwhile, cumulative opioid filling volumes (151.9 OE's in 2010 to 111.7 OE's in 2018) have decreased considerably. Rates of initial opioid prescriptions exceeding 90 OE's were similar in 2010 (6.4%) and 2018 (5.6%). States with legislation targeting duration and volume of opioid prescriptions saw the largest decreases in opioid prescription filling. That is, 75% of states with opioid legislation had large (> 10 oxycodone 5-mg equivalents) decreases in cumulative 90-day opioid filling compared to only 20% of states without opioid legislation having large decreases in cumulative 90-day opioid filling.


This descriptive study demonstrates decreases in perioperative opioid filling for THA. Although this study was descriptive in nature, states enacting opioid-limiting legislation had larger decreases. Although causal relationships could not be inferred from this analysis, the results suggest that states without legislation could improve prescriber compliance with national goals of decreased opioid overprescribing by enacting opioid-limiting legislation.

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Level III, retrospective prognostic cohort study.





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Publication Info

Cunningham, Daniel J, Sean P Ryan, Steven Z George and Brian D Lewis (2021). Opioid legislation and narcotic filling in total hip arthroplasty: descriptive study of time and state-level trends in the United States. Substance abuse treatment, prevention, and policy, 16(1). p. 75. 10.1186/s13011-021-00410-w Retrieved from https://hdl.handle.net/10161/23948.

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Sean Ryan

Assistant Professor of Orthopaedic Surgery

Dr. Sean Ryan is an Adult Reconstruction surgeon in the Division of Orthopaedic Surgery. He specializes in hip and knee primary and revision arthroplasty as well as periacetabular osteotomies for hip dysplasia. His research interests include patient outcomes, implant survivorship, implant design, periprosthetic joint infection, and instability.


Steven Zachary George

Laszlo Ormandy Distinguished Professor of Orthopaedic Surgery

Dr. George’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders.  His long term goals are to 1) improve accuracy for predicting who is going to develop chronic pain; and 2) identify non-pharmacological treatment options that limit the development of chronic pain conditions.  Dr. George is an active member of the American Physical Therapy Association, United States Association of the Study of Pain, and International Association for the Study of Pain. 

Dr. George’s research projects have been supported by the National Institutes of Health, Department of Defense, and Orthopaedic Academy of the American Physical Therapy Association.  Dr. George and his collaborators have authored over 300 peer-reviewed publications in leading medical, orthopaedic surgery, physical therapy, rehabilitation, and pain research journals.  He currently serves as Deputy Editor for Physical Therapy and is an Editorial Board Member for the Journal of Pain. Dr. George has also been involved with clinical practice guideline development for the Academy of Orthopaedic Physical Therapy and the American Psychological Association. 

Dr. George has been recognized with prestigious research awards from the American Physical Therapy Association, American Pain Society, and International Association for the Study of Pain. For example from the American Physical Therapy Association: he was named the  21st John H.P. Maley Lecturer, recognized as a Catherine Worthingham Fellow in 2017, and selected for the Marian Williams Award for Research in Physical Therapy in 2022.    


Brian David Lewis

Assistant Professor of Orthopaedic Surgery

I am an assistant professor in the department of orthopaedics.  My sub-specialty interest is in hip surgery including arthroplasty and non-arthoplasty hip surgery.  This includes the treatment of osteoarthritis, hip dysplasia, hip impingement, labral tears, as well as various tendon disorders around the hip.

The research interests include outcomes research for hip surgeries, hip movement disorders related to hip conditions, and factors influencing opioid use in post-surgical patients.

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