Clinical Depression and the Rate of Joint Arthroplasty Revision

Clinical depression can exacerbate just about everything.

New research from Mayo Clinic has found that treating depression with selective serotonin reuptake inhibitors resulted in a reduced risk of revisions in total joint arthroplasty (TJA).

The study, “Perioperative inpatient Use of Selective Serotonin Reuptake Inhibitors Is Associated With a Reduced Risk of THA and TKA Revision,” was published in the June 2018 edition of Clinical Orthopaedics and Related Research.

The authors wrote, “This was a retrospective study of adult patients who underwent 20,112 primary and revision THAs [total hip arthroplasties] and TKAs [total knee arthroplasties] from January 1, 2002, through December 31, 2009, at a large U.S. tertiary care hospital…”

Co-author Hilal Kremers, M.D. told OTW, “Arthritis patients with chronic joint pain commonly present with depression and various other mood disorders.”

“Depression in these patients is also associated with more pain and increased functional disability. Previous studies suggest that when depressed arthritis patients undergo total hip or knee arthroplasty, they continue to experience worse functional outcomes, more surgical complications and more hospital readmissions.”

“Therefore, there is growing interest in identifying strategies to effectively manage perioperative depression in an effort to improve functional and clinical outcomes in patients undergoing arthroplasty.”

“We confirmed the findings of previous studies regarding an excess risk of revisions among depressed arthroplasty patients. In addition, we examined antidepressant treatment and showed that patients who received Selective Serotonin Reuptake Inhibitors (SSRIs) had a reduced risk of revisions.”

“It is important to screen for depression in patients scheduled for arthroplasty surgery as it is an important risk factor for a variety of adverse surgical outcomes. In terms of effectiveness of SSRI in reducing the risk of revisions, our findings are preliminary and need to be replicated in future studies.”

“This is an observational study and we cannot attribute causality. Future studies with longitudinal SSRI exposure data are warranted to replicate our observations and investigate the potential causative mechanisms for the protective benefit of SSRI in regard to risk of revision in arthroplasty.”

“A diagnosis of depression is associated with a doubling of the risk of infections and the risk of revision arthroplasty. Despite this strong association, depression and psychiatric comorbidities and antidepressant use are rarely considered during the perioperative evaluation of arthroplasty candidates. It is important to recognize and manage psychiatric comorbidities in patients undergoing arthroplasty.”