Total hip replacement (THR) or total knee replacement (TKR) patients who ingest selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for anxiety and depression, may experience a reduced risk of revision surgery, according to a new study.
The reportedly first-of-its-kind study was presented recently at the Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
In the study, researchers reviewed records from more than 20,000 THR and TKR patients age 18 and older from 2002 through 2009. Information gleaned from the review included patient and surgery characteristics and outcomes (dates of care, types of complications, revisions and mortality); as well as SSRI use, determined by medication records from admission through discharge, according to a media release from the AAOS.
The researchers found that a diagnosis of depression was present in 1,290 (6.4%) of patients, and SSRIs were administered in 1,563 (7.8%) of patients. Depression was associated with a doubling of joint infection risk, overall long-term risk of revisions, and revisions for aseptic loosening (a failure of the bond between the bone and the implant).
In addition, the researchers found that SSRI users appeared to have a similar rate of joint infections compared with non-SSRI users. However, patients who received perioperative SSRIs experienced an almost 60% lower rate of revision surgery, including revisions for aseptic loosening.
“While, the potential mechanisms for this finding are currently unknown, we speculate that the lower revision risk in SSRI users may reflect a higher level of health in SSRI users, better management of depression and pain in these patients, or potential positive biologic effects of SSRIs,” says Daniel J. Berry, MD, lead study author and an orthopedic surgeon at the Mayo Clinic in Rochester, Minn.
“Currently there is no laboratory evidence to explain how SSRIs affect the fixation, or success, of orthopaedic implants,” he adds, per the release.
There are some side effects—including bleeding—associated with the use of SSRIs before and after THR and TKR surgery. However, the researchers conclude that there are no detrimental effects on the risk of revision and related complications from their continued use.
“Depression and psychiatric comorbidity and antidepressant medications are rarely considered when evaluating perioperative risk factors among hip and knee replacement candidates,” Berry concludes. “Studies such as this raise awareness to better recognize and manage comorbidities and chronic medications in these patients.”
[Source(s): American Academy of Orthopaedic Surgery, PR Newswire]