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ObjectivesThe optimal use of opioids after knee replacement (KR) remains to be determined, given the growing evidence that opioids are no more effective than other analgesics and that their adverse effects can impair quality of life. Therefore, the objective is to examine opioid prescriptions after KR.DesignIn this retrospective study, we used descriptive statistics and estimated the association of prognostic factors using generalised negative binomial models.SettingThe study is based on anonymised claims data of patients with mandatory health insurance at Helsana, a leading Swiss health insurance.ParticipantsOverall, 9122 patients undergoing KR between 2015 and 2018 were identified.Primary and secondary outcome measuresBased on reimbursed bills, we calculated the dosage (morphine equivalent dose, MED) and the episode length (acute: ResultsOf all patients, 3445 (37.8%) received opioids in the postoperative year. A large majority had acute episodes (3067, 89.0%), 2211 (65.0%) had peak MED levels above 100 mg/day and most patients received opioids in the first 10 postoperative weeks (2881, 31.6%). Increasing age (66–75 and >75 vs 18–65) was associated with decreased IRR (0.776 (95% CI 0.7 to 0.859); 0.723 (95% CI 0.649 to 0.805)), whereas preoperative non-opioid analgesics and opioids were associated with higher IRR (1.271 (95% CI 1.155 to 1.399); 3.977 (95% CI 4.409 to 3.591)).ConclusionThe high opioid demand is unexpected given that current recommendations advise using opioids only when other pain therapies are ineffective. To ensure medication safety, it is important to consider alternative treatment options and ensure that benefits outweigh potential risks.