Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications

Background: The impact of amphetamine abuse on total hip arthroplasty (THA) outcomes has yet to be studied. As the rates of methamphetamine abuse continue to rise, understanding the risk profile of this population is imperative. This study aims to determine the risk of major surgical and medical complications for those with amphetamine abuse undergoing THA, with the hypothesis that amphetamine abuse carries increased risk.

Methods: A retrospective review was performed with all-claims data files of a large national database querying International Classification of Disease, tenth revision, procedure codes identifying 333,038 primary THA, and 1027 with active amphetamine abuse. Medical and surgical complications including infection, dislocation, implant failure, periprosthetic fracture, and revision, as well as length of hospital stay and 90-day readmission rate, were identified. Univariate analysis compared rates of dependent outcomes. To account for independent variables, logistic regression was performed using age, Charlson comorbidity index, sex, obesity, tobacco use, and alcohol use. The results were presented as odds ratios (OR) and P values with significance set at <0.05.

Results: Patients with active amphetamine abuse carried an increased risk of dislocation (OR 1.82, P ≤ .001), infection (OR 2.37, P ≤ .001), mechanical complications (OR 1.64, P ≤ .001), periprosthetic fracture (OR 1.53, P ≤ .05), revision (OR 1.70, P ≤ .001), 90-day readmission (OR 1.79, P ≤ .001), as well as medical complications (1.43, P = .02) compared to those without documented amphetamine abuse.

Conclusions: Patients with amphetamine abuse are at increased risk of postoperative surgical and medical complications following THA. We recommend consideration of these risks prior to primary THA in this patient population.