Evaluating the Effects of Perioperative Ketorolac Use on Uncemented Total Hip Arthroplasty Outcomes

<b>Background/Objectives</b>: Ketorolac is commonly used for pain management after orthopedic surgery, but concerns regarding its effects on postoperative complications remain. This study evaluates the impact of ketorolac use on short- and long-term outcomes in adult patients undergoing uncemented primary total hip arthroplasty (THA), where implant stability relies on biological fixation through bone ingrowth into a porous-coated prosthesis rather than bone cement. <b>Methods</b>: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 18 years or older who underwent uncemented primary THA between 1 January 2004 and 1 January 2024 were included. Two cohorts were compared: those who received ketorolac on the day of or within one week of surgery and those who did not. Cohorts were propensity score-matched. Outcomes were assessed at 30 days, 1 year, and 5 years postoperatively. <b>Results</b>: At 30 days, ketorolac use was associated with significantly lower risks of transfusion (RR: 0.6, <i>p</i> < 0.01). However, it was linked to higher rates of acute posthemorrhagic anemia (RR: 1.2, <i>p</i> < 0.01) and periprosthetic fracture (RR: 1.4, <i>p</i> < 0.01). At 1 year, ketorolac use was associated with reduced risks of death (RR: 0.8, <i>p</i> < 0.01) and transfusion (RR: 0.7, <i>p</i> < 0.01), but increased risks of acute posthemorrhagic anemia (RR: 1.2, <i>p</i> < 0.01), deep surgical site infection (SSI) (RR: 1.8, <i>p</i> = 0.01), superficial SSI (RR: 1.9, <i>p</i> < 0.01), periprosthetic joint infection (RR: 1.1, <i>p</i> < 0.01), wound dehiscence (RR: 1.2, <i>p</i> < 0.01), periprosthetic mechanical complication (RR: 1.2, <i>p</i> < 0.01), and periprosthetic fracture (RR: 1.5, <i>p</i> < 0.01). <b>Conclusions</b>: Our findings highlight the complex risk profile of ketorolac in uncemented THA patients and suggest that clinicians should carefully consider individual patient factors and engage in shared decision-making when counseling patients on the use of ketorolac in the perioperative setting.