From the Temerty Faculty of Medicine, University of Toronto, Toronto, ON (Chaudhry), the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON (Morgan), the Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON (Kruse), the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON (Wolfstadt), and the Granovsky Gluskin Division of Orthopaedics, Sinai Health System, Toronto, ON (Wolfstadt, and Ekhtiari).
J Am Acad Orthop Surg. 2024 Jul 15;32(14):647-655. doi: 10.5435/JAAOS-D-23-01130. Epub 2024 Apr 10.
Depression is a notable contributor to suboptimal outcomes after total joint arthroplasty (TJA). We conducted a systematic review of comparative studies to review the available evidence of interventions that affected depression scores and/or outcomes for patients undergoing TJA.
EMBASE, Ovid MEDLINE, PubMed, and Scopus were reviewed systematically from inception until November 15, 2022. Studies that were relevant for this review included comparative studies between patients who received an intervention within 3 months before or after their primary total hip or knee arthroplasty procedure. The interventions included a wide range of modalities, which were grouped into psychotherapy, enhanced perioperative support, and pharmacotherapy. Other interventions included physiotherapy techniques with a psychological focus, art/music-based therapy, occupational therapy support, and educational interventions. Meta-analysis was conducted for psychotherapy and enhanced support.
The final systematic review consisted of 28 relevant studies, most of which were randomized controlled trials. A total of 3,702 patients, with a mean age of 66 years, were considered, of whom 59% were female. Most of the studies reported a notable reduction in depressive symptoms and/or scores based on the interventions being analyzed. At 3 months postoperatively, psychotherapy and enhanced support both resulted in markedly better depression and function scores compared with control subjects, with psychotherapy additionally improving pain scores.
Overall, a wide range of interventions aimed at psychological optimization of patients undergoing TJA can improve depressive symptoms, pain, and function, even in the absence of a formal diagnosis of depression. Specifically, cognitive-based psychotherapy and enhanced perioperative support had the best evidence. Routine pharmacotherapy plays a limited role, if any, in the care of TJA. Additional efforts to develop pragmatic, evidence-based, and reproducible interventions are warranted to continue to optimize outcomes in TJA patients.
抑郁症是全膝关节或髋关节置换术后结局欠佳的一个显著影响因素。我们进行了一项系统评价，旨在回顾分析可能影响全膝关节或髋关节置换术患者抑郁评分和/或结局的干预措施的相关证据。
我们系统检索了 EMBASE、Ovid MEDLINE、PubMed 和 Scopus 数据库，检索时间从建库至 2022 年 11 月 15 日。本研究纳入了在初次全髋关节或全膝关节置换术 3 个月前或后接受干预的患者的对照研究。纳入的干预措施包括心理疗法、强化围手术期支持和药物治疗等多种方式。其他干预措施包括具有心理治疗重点的物理治疗技术、艺术/音乐疗法、职业治疗支持和教育干预。对心理疗法和强化支持进行了 meta 分析。
最终的系统评价共纳入 28 项相关研究，其中大多数为随机对照试验。共纳入 3702 例患者，平均年龄 66 岁，其中 59%为女性。大多数研究报告称，基于所分析的干预措施，抑郁症状和/或评分显著减轻。术后 3 个月时，与对照组相比，心理疗法和强化支持均显著改善了抑郁和功能评分，心理疗法还改善了疼痛评分。
总体而言，旨在优化接受全膝关节或髋关节置换术患者心理状态的各种干预措施可改善抑郁症状、疼痛和功能，即使患者没有正式的抑郁诊断也是如此。具体而言，基于认知的心理疗法和强化围手术期支持具有最佳证据。常规药物治疗在全膝关节或髋关节置换术患者的治疗中作用有限，如果有作用的话。需要进一步努力开发实用、基于证据和可重复的干预措施，以继续优化全膝关节或髋关节置换术患者的结局。
