Background: Opioid use is a public health crisis in the United States and an area of increased focus in orthopaedic surgery. The aim of this study is to investigate whether preoperative opioid use had any effect on patient-reported outcome measures (PROMs) before and after total hip arthroplasty (THA). Methods: A total of 389 patients with THA with both preoperative and postoperative PROMs were reviewed: (1) 76 patients with preoperative opioid use (24%) and (2) 237 patients without preoperative opioid use (76%). Patient demographics and clinical information including opioid use, length of stay, and implant information.Results: Preoperative opioid users were more likely to stay in the hospital longer (P = 0.004) and be discharged to a rehabilitation facility (P = 0.038). Postoperatively, the Physical Function Short Form 10a (P = 0.021) and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001 physical, P = 0.001, mental) were significantly lower in the preoperative opioid users. Within groups, both nonusers and preoperative opioid users saw improvements after THA in Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (P , 0.001), Short Form 10a (P , 0.001), and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001, physical and P = 0.008, mental). Discussion: Although all patients reported improvements after THA regardless of preoperative opioid use, preoperative opioid users undergoing THA had significantly lower patient-reported outcome scores, longer hospital stays, and a more likely discharge to rehabilitation.B eginning with the initiation of the American Pain Society "Pain, The Fifth Vital Sign" campaign in the 1990s and the subsequent mandate by the Joint Commission on the Accreditation of Healthcare Organizations to provide pain assessment and treatment for all patients in ac-credited healthcare settings, an opioid epidemic has risen in the United States. 1 Opioid use is the leading cause of accidental death in the United States, and more than 2.4 million Americans have a severe opioid use disorder. 2 Consequently, increasing focus has been placed on

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