Few studies have evaluated the impact of preoperative opioid use on risk of subsequent revision following primary total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative opioid use is associated with an increased risk of early revision TKA. The Humana administrative claims database was queried to identify patients who underwent unilateral TKA during the years 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision procedure within 2 years. Preoperative opioid use was defined as having an opioid prescription filled within the 3 months before TKA. Age, sex, diabetes, obesity, chronic kidney disease, and anxiety/depression were also analyzed. Univariate and multivariate analyses were performed. A total of 35,894 primary TKA patients were identified and 1.2% (n = 413) had a revision TKA procedure within 2 years. 29.2% of patients filled an opioid prescription within the 3 months before TKA. Preoperative opioid users were significantly more likely to undergo early TKA revision (1.6% vs 1.0%, P < .001). Preoperative opioid use (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.25-1.88; P < .001), younger age (OR, 2.46; 95% CI, 1.43-3.95; P < .001), obesity (OR, 1.25; 95% CI, 1.01-1.56; P = .04), and smoking (OR, 1.66; 95% CI, 1.22-2.22; P < .001) were associated with early revision TKA. This study identified preoperative opioid use as being independently associated with a greater risk for an early revision TKA. Younger age, obesity, and smoking were also associated with elevated risk. These findings support efforts to reduce inappropriate opioid prescribing.