J. J. Yao, H. Maradit Kremers, D. G. Lewallen, D. J. Berry, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA W. K. Kremers, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Clin Orthop Relat Res. 2018 Jun;476(6):1191-1197. doi: 10.1007/s11999.0000000000000098.
Depression is common in the general population, and so it is likewise common among patients undergoing THA and TKA. Depression is associated with lower perioperative patient-reported outcomes and an increased risk of postoperative complications. Antidepressants are effective in managing symptoms of depression and may potentially contribute to better functional status and better clinical outcomes after THA and TKA.
QUESTIONS/PURPOSES: We examined (1) whether perioperative depression is associated with all-cause revisions, revisions for aseptic loosening, revisions without infection, and periprosthetic joint infections (PJIs) in patients undergoing THA and TKA; and (2) whether perioperative antidepressant use reduces the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions, and PJIs in patients undergoing THA and TKA.
This was a retrospective study of adult patients (≥ 18 years) who underwent 20,112 primary and revision THAs and TKAs from January 1, 2002, through December 31, 2009, at a large US tertiary care hospital. Data on patient and surgery characteristics and outcomes (dates and types of revisions, death) were ascertained through the institutional joint registry. Perioperative antidepressant use was assessed by searching the daily medication administration records beginning at admission and ending at discharge. A diagnosis of depression was present in 4466 (22%), and antidepressants were administered at the time of 5077 (25%) surgical procedures. Multivariable Cox proportional hazard models were used to estimate associations between antidepressant use and the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions, and PJIs.
Depression was associated with an increased risk of all-cause revisions (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.42-2.02; p < 0.001) and PJIs (HR, 2.23; 95% CI, 1.53-3.17; p < 0.001). Overall, perioperative antidepressant use was not associated with the risk of revision or PJI, but selective serotonin reuptake inhibitor (SSRI) users had a lower risk of all-cause revisions (HR, 0.77; 95% CI, 0.61-0.96; p = 0.001) and aseptic revisions (HR, 0.72; 95% CI, 0.56-0.93; p = 0.013).
The presence of a depression diagnosis confers an increased risk of revision and PJI among patients undergoing THA and TKA, yet the risk is lower within the subset of patients who received SSRIs during the perioperative period. Future longitudinal studies with detailed antidepressant medication histories are warranted to better understand the potential biologic effects of SSRI on the risk of revision in patients undergoing THA and TKA.
Level III, therapeutic study.
抑郁症在普通人群中很常见，因此在接受全髋关节置换术（THA）和全膝关节置换术（TKA）的患者中也很常见。抑郁症与围手术期患者报告的结局较差以及术后并发症风险增加有关。抗抑郁药在治疗抑郁症症状方面有效，并且可能有助于改善 THA 和 TKA 后的功能状态和临床结局。
问题/目的：我们研究了（1）围手术期抑郁症是否与 THA 和 TKA 患者的全因翻修、无菌性松动翻修、无感染翻修和假体周围关节感染（PJI）有关；以及（2）围手术期使用抗抑郁药是否降低了 THA 和 TKA 患者的全因翻修、无菌性松动翻修、无菌翻修和 PJI 的风险。
这是一项对 20112 例接受初次和翻修 THA 和 TKA 的成年患者（≥18 岁）的回顾性研究，这些患者于 2002 年 1 月 1 日至 2009 年 12 月 31 日期间在一家美国大型三级护理医院接受治疗。通过机构关节登记处确定患者和手术特征以及结局（翻修日期和类型、死亡）的数据。通过搜索入院和出院时的每日药物管理记录来评估围手术期抗抑郁药的使用情况。在 4466 例（22%）患者中存在抑郁症，在 5077 例（25%）手术中使用了抗抑郁药。使用多变量 Cox 比例风险模型来估计抗抑郁药使用与全因翻修、无菌性松动翻修、无菌翻修和 PJI 风险之间的关联。
抑郁症与全因翻修（风险比[HR]，1.73；95%置信区间[CI]，1.42-2.02；p<0.001）和 PJI（HR，2.23；95%CI，1.53-3.17；p<0.001）的风险增加有关。总体而言，围手术期使用抗抑郁药与翻修或 PJI 的风险无关，但选择性 5-羟色胺再摄取抑制剂（SSRI）使用者的全因翻修（HR，0.77；95%CI，0.61-0.96；p=0.001）和无菌翻修（HR，0.72；95%CI，0.56-0.93；p=0.013）的风险较低。
在接受 THA 和 TKA 的患者中，抑郁症的诊断会增加翻修和 PJI 的风险，但在接受围手术期 SSRI 治疗的患者亚组中，风险较低。需要进行未来的纵向研究，以详细了解抗抑郁药的使用情况，从而更好地了解 SSRI 对接受 THA 和 TKA 患者翻修风险的潜在生物学影响。
III 级，治疗性研究。
