Jeong Suin, Lee Ji Won, Shaya Elias K, Boucher Henry R
Orthopaedics, MedStar Georgetown University Hospital, Washington, USA.
Orthopaedics, MedStar Union Memorial Hospital, Baltimore, USA.
Cureus. 2025 Apr 1;17(4):e81563. doi: 10.7759/cureus.81563. eCollection 2025 Apr.
Background and objective Some patients without pre-existing depression develop new-onset depression (NOD) following total joint arthroplasty (TJA), potentially impacting recovery and quality of life. New-onset depression has been associated with increased TJA complications (i.e., periprosthetic fracture, prosthetic joint infection, and revision), but the role of antidepressants in this population remains unexplored. This paper assessed the prevalence of antidepressant use in TJA patients with NOD and its association with postoperative complications. Methods We conducted a retrospective cohort study using a national database (2010-2022). Primary TJA patients aged ≥18 years with osteoarthritis and NOD within six months were included, while those with preoperative depression, antidepressant use, or < one-year follow-up were excluded. Study groups comprised those on antidepressants; controls consisted of those not on antidepressants. Logistic regressions adjusting for age, sex, and comorbidities assessed the odds of one-year postoperative complications. Results Among TJA patients with NOD, 25.3% (n=1,735) of total hip arthroplasty (THA) and 27.6% (n=4,365) of total knee arthroplasty (TKA) patients used antidepressants. Total hip arthroplasty patients on antidepressants had 1.70 times higher odds of periprosthetic fracture (95% CI: 1.22, 2.36) but showed no significant differences in prosthetic joint infection or revision. No significant differences were found in the TKA group. Conclusions Antidepressant use in NOD was not associated with reduced arthroplasty-related complications; however, treating depressive symptoms may still aid recovery. Further research, incorporating patient-level data on depression severity, therapy, and social support, antidepressant subclassification, and medication dosing and duration, is needed to identify which patients benefit from antidepressants and optimize postoperative mental health management.
一些既往无抑郁症的患者在全关节置换术（TJA）后出现新发抑郁症（NOD），这可能会影响康复及生活质量。新发抑郁症与TJA并发症增加（即假体周围骨折、人工关节感染和翻修）有关，但抗抑郁药在该人群中的作用仍未得到探索。本文评估了NOD的TJA患者中抗抑郁药的使用情况及其与术后并发症的关联。方法：我们使用国家数据库（2010 - 2022年）进行了一项回顾性队列研究。纳入年龄≥18岁、患有骨关节炎且在6个月内出现NOD的初次TJA患者，排除术前有抑郁症、使用抗抑郁药或随访时间<1年的患者。研究组包括使用抗抑郁药的患者；对照组由未使用抗抑郁药的患者组成。在对年龄、性别和合并症进行调整的逻辑回归分析中，评估术后1年并发症的几率。结果：在患有NOD的TJA患者中，全髋关节置换术（THA）患者中有25.3%（n = 1735）、全膝关节置换术（TKA）患者中有27.6%（n = 4365）使用了抗抑郁药。使用抗抑郁药的THA患者发生假体周围骨折的几率高1.70倍（95%CI：1.22，2.36），但在人工关节感染或翻修方面无显著差异。TKA组未发现显著差异。结论：NOD患者使用抗抑郁药与降低关节置换术相关并发症无关；然而，治疗抑郁症状仍可能有助于康复。需要进一步开展研究，纳入有关抑郁严重程度、治疗及社会支持的患者层面数据、抗抑郁药亚分类以及药物剂量和疗程，以确定哪些患者能从抗抑郁药中获益并优化术后心理健康管理。
