Opioid Use Disorder Significantly Increases Complications and Costs in Primary and Revision Total Knee Arthroplasty a Nationwide Analysis and the Case for Preoperative Screening

<b>Background:</b> Total knee arthroplasty (TKA) is one of the most frequently performed procedures for end-stage arthritis. Effective pain control is essential for recovery, and opioids are widely used. However, patients with opioid use disorder (OUD) may be at increased risk of complications. <b>Methods:</b> We analyzed 2,514,099 TKA cases from the Nationwide Inpatient Sample (2016-2019), identifying 11,785 patients with OUD. After 1:1 propensity score matching, clinical and economic outcomes were compared between OUD and non-OUD patients. <b>Results:</b> Patients with OUD had significantly higher odds of intraoperative fracture (OR: 6.1), DVT (OR: 5.0), pneumonia (OR: 2.5), pulmonary edema (OR: 1.6), and blood transfusion (OR: 1.5) (<i>p</i> < 0.001). Mean hospital charges were higher (USD 68,687 vs. USD 60,984), and LOS was longer (2.8 vs. 2.5 days, <i>p</i> < 0.001). OUD patients were more likely to undergo revision TKA at a younger age (59.6 vs. 65.4 years, <i>p</i> = 0.016), with higher infection rates and greater costs. <b>Conclusions:</b> Patients with OUD undergoing TKA experience more complications, higher costs, and require earlier revision. Underreporting of OUD highlights the need for improved preoperative screening.