Effect of SSRIs and Depression On Revisions After Hip or Knee Replacement

MedicalResearch.com Interview with:

Hilal Maradit Kremers, M.D. M.Sc.   Associate Professor of Epidemiology Mayo Clinic College of Medicine

Dr. Hilal Maradit Kremers

Hilal Maradit Kremers, M.D. M.Sc. 
Associate Professor of Epidemiology
Mayo Clinic College of Medicine 

MedicalResearch.com: What is the background for this study?

Response: Depression and mood disorders are common comorbidities in patients undergoing total hip and total knee arthroplasty.  Based on previous research, there is evidence to suggest presence of depression in arthroplasty patients is associated with worse functional and clinical outcomes, such as complications, readmissions and mortality.  Although the mechanisms are poorly understood, it is important to identify strategies to effectively manage perioperative depression in an effort to improve arthroplasty outcomes.  One potential strategy is effective medical treatment of underlying depression which can potentially improve depression symptoms, thereby surgical outcomes.

MedicalResearch.com: What are the main findings?

Response: We performed an observational study and reviewed the medical records 20,000 total hip and total knee arthroplasty patients at our institution. We found that 7.8% of patients were receiving selective serotonin reuptake inhibitors (SSRIs) at the time of surgery. Similar to the findings of previous studies, a diagnosis of depression was significant associated with excess risk of various adverse outcomes, including infections, revisions and revisions for aseptic loosening (a failure of the bond between the bone and the implant). Yet, patients who received perioperative SSRIs experienced an almost 60% lower rate of revision surgery, including revisions for aseptic loosening.

MedicalResearch.com: What should readers take away from your report?

Response: While the use of SSRIs before and after surgery has been associated with some side effects, including bleeding, readers may want to know that the continuation of SSRI around the time of total hip and total knee arthroplasty surgery does not have detrimental effects on the risk of revision and related complications.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: This is the first study reporting on reduced risk of revisions among SSRI users. Further research is necessary to replicate these findings in other cohorts.  Furthermore, there is no laboratory evidence to date to explain how SSRIs may affect the fixation, or success, of orthopedic implants.  Basic research studies are warranted to better understand the potential biological mechanisms. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Depression and psychiatric comorbidity and antidepressant medications are rarely considered when evaluating perioperative risk factors among hip and knee arthroplasty candidates. Studies such as this raise awareness to better recognize and manage comorbidities and chronic medications in these patients.

Authors have no relevant disclosures related to this study. 

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Citation: Abstract presented at the AAOS 2017

Depression, Selective Serotonin Reuptake Inhibitors, and the Outcomes of Total Hip and Knee Arthroplasty Hilal Maradit-Kremers, Walter K Kremers1 , David G Lewallen1 , Daniel J Berry

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