{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:31:58Z","timestamp":1793046718233,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depression is common in the general population, and so it is likewise common among patients undergoing THA and TKA. Depression is associated with lower perioperative patient-reported outcomes and an increased risk of postoperative complications. Antidepressants are effective in managing symptoms of depression and may potentially contribute to better functional status and better clinical outcomes after THA and TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Questions\/purposes<\/jats:title>\n                    <jats:p>We examined (1) whether perioperative depression is associated with all-cause revisions, revisions for aseptic loosening, revisions without infection, and periprosthetic joint infections (PJIs) in patients undergoing THA and TKA; and (2) whether perioperative antidepressant use reduces the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions, and PJIs in patients undergoing THA and TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study of adult patients (\u2265 18 years) who underwent 20,112 primary and revision THAs and TKAs from January 1, 2002, through December 31, 2009, at a large US tertiary care hospital. Data on patient and surgery characteristics and outcomes (dates and types of revisions, death) were ascertained through the institutional joint registry. Perioperative antidepressant use was assessed by searching the daily medication administration records beginning at admission and ending at discharge. A diagnosis of depression was present in 4466 (22%), and antidepressants were administered at the time of 5077 (25%) surgical procedures. Multivariable Cox proportional hazard models were used to estimate associations between antidepressant use and the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions, and PJIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Depression was associated with an increased risk of all-cause revisions (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.42-2.02; p &lt; 0.001) and PJIs (HR, 2.23; 95% CI, 1.53-3.17; p &lt; 0.001). Overall, perioperative antidepressant use was not associated with the risk of revision or PJI, but selective serotonin reuptake inhibitor (SSRI) users had a lower risk of all-cause revisions (HR, 0.77; 95% CI, 0.61-0.96; p = 0.001) and aseptic revisions (HR, 0.72; 95% CI, 0.56-0.93; p = 0.013).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The presence of a depression diagnosis confers an increased risk of revision and PJI among patients undergoing THA and TKA, yet the risk is lower within the subset of patients who received SSRIs during the perioperative period. Future longitudinal studies with detailed antidepressant medication histories are warranted to better understand the potential biologic effects of SSRI on the risk of revision in patients undergoing THA and TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, therapeutic study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000098","type":"journal-article","created":{"date-parts":[[2018,6,28]],"date-time":"2018-06-28T11:17:14Z","timestamp":1530184634000},"page":"1191-1197","source":"Crossref","is-referenced-by-count":41,"title":["Perioperative Inpatient Use of Selective Serotonin Reuptake Inhibitors Is Associated With a Reduced Risk of THA and TKA Revision"],"prefix":"10.1097","volume":"476","author":[{"given":"Jie J.","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal","family":"Maradit Kremers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter K.","family":"Kremers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Lewallen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Berry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,12]]},"reference":[{"key":"R1-20230814","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s00228-014-1676-z","article-title":"Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications","volume":"70","author":"Abbing-Karahagopian","year":"2014","journal-title":"Eur J Clin Pharmacol."},{"key":"R2-20230814","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1001\/jamainternmed.2013.714","article-title":"Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery","volume":"173","author":"Auerbach","year":"2013","journal-title":"JAMA Intern Med."},{"key":"R3-20230814","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.arth.2013.08.025","article-title":"Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study","volume":"29","author":"Browne","year":"2014","journal-title":"J Arthroplasty."},{"key":"R4-20230814","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.arth.2014.08.034","article-title":"The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database","volume":"30","author":"Buller","year":"2015","journal-title":"J Arthroplasty."},{"key":"R5-20230814","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/S0140-6736(09)60046-5","article-title":"Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis","volume":"373","author":"Cipriani","year":"2009","journal-title":"Lancet."},{"key":"R6-20230814","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/rheumatology\/39.5.490","article-title":"Factors associated with functional impairment in symptomatic knee osteoarthritis","volume":"39","author":"Creamer","year":"2000","journal-title":"Rheumatology."},{"key":"R7-20230814","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.phrs.2015.11.021","article-title":"Immunomodulatory effects of fluoxetine: a new potential pharmacological action for a classic antidepressant drug?","volume":"109","author":"Di Rosso","year":"2016","journal-title":"Pharmacol Res."},{"key":"R8-20230814","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/annrheumdis-2013-204223","article-title":"Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)","volume":"73","author":"Dougados","year":"2014","journal-title":"Ann Rheum Dis."},{"key":"R9-20230814","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care."},{"key":"R10-20230814","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12893-016-0120-y","article-title":"Depression and postoperative complications: an overview","volume":"16","author":"Ghoneim","year":"2016","journal-title":"BMC Surg."},{"key":"R11-20230814","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/j.arth.2016.04.010","article-title":"Association of depression with 90-day hospital readmission after total joint arthroplasty","volume":"31","author":"Gold","year":"2016","journal-title":"J Arthroplasty."},{"key":"R12-20230814","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1155\/2010\/365341","article-title":"Depressive symptoms and one year mortality among elderly patients discharged from a rehabilitation ward after orthopaedic surgery of the lower limbs","volume":"23","author":"Guerini","year":"2010","journal-title":"Behav Neurol."},{"key":"R13-20230814","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.bone.2009.07.083","article-title":"Effects of selective serotonin reuptake inhibitors on bone health in adults: time for recommendations about screening, prevention and management?","volume":"46","author":"Haney","year":"2010","journal-title":"Bone."},{"key":"R14-20230814","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.arth.2016.01.063","article-title":"Should we think twice about psychiatric disease in total hip arthroplasty?","volume":"31","author":"Klement","year":"2016","journal-title":"J Arthroplasty."},{"key":"R15-20230814","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.knee.2016.05.007","article-title":"Psychiatric disorders increase complication rate after primary total knee arthroplasty","volume":"23","author":"Klement","year":"2016","journal-title":"Knee."},{"key":"R16-20230814","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s40263-015-0231-5","article-title":"Serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor use and risk of fractures: a new-user cohort study among US adults aged 50 years and older","volume":"29","author":"Lanteigne","year":"2015","journal-title":"CNS Drugs."},{"key":"R17-20230814","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1001\/jama.290.18.2428","article-title":"IMPACT Investigators. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial","volume":"290","author":"Lin","year":"2003","journal-title":"JAMA."},{"key":"R18-20230814","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/archfami.9.10.1052","article-title":"Can depression treatment in primary care reduce disability? A stepped care approach","volume":"9","author":"Lin","year":"2000","journal-title":"Arch Fam Med."},{"key":"R19-20230814","first-page":"645","article-title":"General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis","volume":"50","author":"Memel","year":"2000","journal-title":"Br J Gen Pract."},{"key":"R20-20230814","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.4088\/JCP.v69n0704","article-title":"National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication","volume":"69","author":"Mojtabai","year":"2008","journal-title":"J Clin Psychiatry."},{"key":"R21-20230814","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0140-6736(07)61415-9","article-title":"Depression, chronic diseases, and decrements in health: results from the World Health Surveys","volume":"370","author":"Moussavi","year":"2007","journal-title":"Lancet."},{"key":"R22-20230814","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1001\/archinte.163.19.2354","article-title":"Relationship of serotonergic antidepressants and need for blood transfusion in orthopedic surgical patients","volume":"163","author":"Movig","year":"2003","journal-title":"Arch Intern Med."},{"key":"R23-20230814","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1001\/jamainternmed.2013.718","article-title":"Selective serotonin reuptake inhibitors and surgery: to hold or not to hold, that is the question: comment on 'Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery.'","volume":"173","author":"Mrkobrada","year":"2013","journal-title":"JAMA Intern Med."},{"key":"R24-20230814","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin Infect Dis."},{"key":"R25-20230814","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/j.1445-2197.2010.05634.x","article-title":"Preoperative psychological distress and functional outcome after knee replacement","volume":"81","author":"Paulsen","year":"2011","journal-title":"ANZ J Surg."},{"key":"R26-20230814","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.arth.2013.04.030","article-title":"Influence of depression on total knee arthroplasty outcomes","volume":"29","author":"Perez-Prieto","year":"2014","journal-title":"J Arthroplasty."},{"key":"R27-20230814","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/npp.2016.194","article-title":"Pathogen-host defense in the evolution of depression: insights into epidemiology, genetics, bioregional differences and female preponderance","volume":"42","author":"Raison","year":"2017","journal-title":"Neuropsychopharmacology."},{"key":"R28-20230814","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.arth.2015.09.015","article-title":"Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression","volume":"31","author":"Rasouli","year":"2016","journal-title":"J Arthroplasty."},{"key":"R29-20230814","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.arth.2009.04.002","article-title":"Major depression, generalized anxiety disorder, and panic disorder in patients scheduled for knee arthroplasty","volume":"25","author":"Riddle","year":"2010","journal-title":"J Arthroplasty."},{"key":"R30-20230814","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.bone.2012.05.018","article-title":"Antidepressant medications and osteoporosis","volume":"51","author":"Rizzoli","year":"2012","journal-title":"Bone."},{"key":"R31-20230814","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1302\/0301-620X.91B2.20765","article-title":"Variables determining outcome in total hip replacement surgery","volume":"91","author":"Rolfson","year":"2009","journal-title":"J Bone Joint Surg Br."},{"key":"R32-20230814","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0006-3223(98)00126-7","article-title":"Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial","volume":"44","author":"Rosenbaum","year":"1998","journal-title":"Biol Psychiatry."},{"key":"R33-20230814","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s10067-009-1267-z","article-title":"Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty","volume":"28","author":"Singh","year":"2009","journal-title":"Clin Rheumatol."},{"key":"R34-20230814","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/1471-2474-11-90","article-title":"Predictors of pain and use of pain medications following primary total hip arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years","volume":"11","author":"Singh","year":"2010","journal-title":"BMC Musculoskelet Disord."},{"key":"R35-20230814","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/1471-2474-15-127","article-title":"Depression in primary TKA and higher medical comorbidities in revision TKA are associated with suboptimal subjective improvement in knee function","volume":"15","author":"Singh","year":"2014","journal-title":"BMC Musculoskelet Disord."},{"key":"R36-20230814","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.4088\/JCP.14m09147","article-title":"Depression and multimorbidity: a cross-sectional study of 1,751,841 patients in primary care","volume":"75","author":"Smith","year":"2014","journal-title":"J Clin Psychiatry."},{"key":"R37-20230814","first-page":"125","article-title":"Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics","volume":"25","author":"van Baar","year":"1998","journal-title":"J Rheumatol."},{"key":"R38-20230814","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/ALN.0b013e3181cf8fdf","article-title":"Use of serotonergic antidepressants and bleeding risk in orthopedic patients","volume":"112","author":"van Haelst","year":"2010","journal-title":"Anesthesiology."},{"key":"R39-20230814","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0278-5846(02)00338-X","article-title":"Role of selective serotonin reuptake inhibitors in psychiatric disorders: a comprehensive review","volume":"27","author":"Vaswani","year":"2003","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry."},{"key":"R40-20230814","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.semarthrit.2011.07.003","article-title":"Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review","volume":"41","author":"Vissers","year":"2012","journal-title":"Semin Arthritis Rheum."},{"key":"R41-20230814","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.1989.03430070062031","article-title":"The functioning and well-being of depressed patients. Results from the Medical Outcomes Study","volume":"262","author":"Wells","year":"1989","journal-title":"JAMA."},{"key":"R42-20230814","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1177\/0022034514549378","article-title":"Selective serotonin reuptake inhibitors and the risk of osseointegrated implant failure: a cohort study","volume":"93","author":"Wu","year":"2014","journal-title":"J Dent Res."}],"container-title":["Clinical Orthopaedics &amp; Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00003086-201806000-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T01:11:21Z","timestamp":1691975481000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00003086-201806000-00014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,12]]},"references-count":42,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1007\/s11999.0000000000000098","relation":{},"ISSN":["0009-921X"],"issn-type":[{"value":"0009-921X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,12]]}}}