Antidepressant Use in New-Onset Depression After Total Joint Arthroplasty Is Not Associated With Reduced Arthroplasty-Related Complications

TL;DR

This study finds that using antidepressants after joint replacement surgery in patients with new-onset depression does not reduce surgical complications.

Contribution

The study is the first to explore the association between antidepressant use and postoperative complications in patients with new-onset depression after joint surgery.

Findings

Antidepressant use was not linked to fewer complications in patients with new-onset depression after joint surgery.

THA patients on antidepressants had higher odds of periprosthetic fracture, but no effect on infection or revision.

No significant association was found between antidepressant use and complications in TKA patients.

Abstract

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.

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