{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:50:33Z","timestamp":1791503433751,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82372392"],"award-info":[{"award-number":["82372392"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018525","name":"Key Research and Development Program of Sichuan Province","doi-asserted-by":"publisher","award":["2024YFFK0136"],"award-info":[{"award-number":["2024YFFK0136"]}],"id":[{"id":"10.13039\/501100018525","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2025ZNSFSC1569"],"award-info":[{"award-number":["2025ZNSFSC1569"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n The impact of psychological factors on surgical stress response has garnered extensive attention. However, perioperative intervention strategies are still lacking for the total hip arthroplasty (THA) population without psychiatric comorbidities. This study aimed to assess the efficacy of duloxetine in perioperative anxiety status and stress response in these patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a double\u2010blind randomized controlled trial conducted between September 2021 and August 2024. Eligible patients aged over 18\u2009years scheduled for unilateral primary total hip arthroplasty were recruited, with exclusion of patients with diagnosed mental diseases, endocrine disorders, previous psychiatric medication use, or severe hepatorenal dysfunction. A computer\u2010generated random sequence was used to assign 100 patients to either the duloxetine group or the placebo group. The patients received 60\u2009mg of duloxetine or the placebo daily starting 2\u2009days before the surgery to postoperative day two. The primary outcome was the anxiety status assessed using the Hamilton anxiety scale (HAMA). The self\u2010rating anxiety scale (SAS), stress response\u2010related inflammatory levels and neuroendocrine levels, visual analog scale (VAS), patient satisfaction, quality of recovery\u201015 (QoR\u201015) score, Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, and adverse effects were also compared. Continuous outcomes with multiple time points were analyzed using linear mixed models, while single time point outcomes used\n t<\/jats:italic>\n \u2010test or Mann\u2013Whitney\n U<\/jats:italic>\n test. Preoperative to POD1 differences were assessed with paired\n t<\/jats:italic>\n \u2010test or Wilcoxon test. Categorical variables and response rate were analyzed using chi\u2010square or Fisher's exact test. Correlation analysis examined anxiety and stress biomarker relationships. Statistical significance was set at\n p<\/jats:italic>\n \u2009<\u20090.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The duloxetine group had significantly lower HAMA and SAS scores than the placebo group on POD2 (both\n p<\/jats:italic>\n \u2009<\u20090.05). The VAS score during walking was significantly lower in the duloxetine group (\n p<\/jats:italic>\n \u2009<\u20090.05). Patients in the duloxetine group exhibited higher QoR\u201015, HHS, and UCLA scores and better satisfaction (all\n p<\/jats:italic>\n \u2009<\u20090.05). The erythrocyte sedimentation rate (ESR), neutrophil\/lymphocyte ratio (NLR), tumor necrosis factor alpha (TNF\u2010\u03b1), adrenocorticotropic hormone (ACTH), plasma cortisol (PTC), and blood glucose (BG) were significantly lower in the duloxetine group (all\n p<\/jats:italic>\n \u2009<\u20090.05). The ESR and HAMA, ACTH and SAS, and PTC and SAS were respectively correlated (all\n p<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The perioperative administration of duloxetine alleviated anxiety, reduced postoperative walking pain, improved the quality of functional recovery and satisfaction, and may reduce the stress response in patients undergoing THA.<\/jats:p>\n \n Trial Registration:<\/jats:bold>\n Clinical Trial Register: ChiCTR2100051099.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/os.70436","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:15:55Z","timestamp":1791501355000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Duloxetine on the Perioperative Anxiety Status and Stress Response Following Total Hip Arthroplasty: A Randomized Controlled Trial"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6700-0561","authenticated-orcid":false,"given":"Bohua","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu China"},{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute, West China School of Public Health and West China Fourth Hospital Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manxue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Mental Health Center, National Center for Mental Disorders West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-2271","authenticated-orcid":false,"given":"Qianhao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-0041","authenticated-orcid":false,"given":"Lijun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyile","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5886-9727","authenticated-orcid":false,"given":"Xiaobing","family":"Pu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute, West China School of Public Health and West China Fourth Hospital Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4480-9664","authenticated-orcid":false,"given":"Pengde","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"3","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.otsr.2025.104222","article-title":"Impact of Enhanced Recovery After Surgery on Psychological Outcomes in Total Hip Arthroplasty","volume":"112","author":"Xing G.","year":"2026","journal-title":"Orthopaedics & Traumatology, Surgery & Research"},{"issue":"1","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"132.e134","DOI":"10.1016\/j.arth.2025.06.013","article-title":"Anxiety and Depression Symptoms Are Associated With Inferior Outcomes in Patients Undergoing Total Hip Arthroplasty: A Prospective Cohort Study","volume":"41","author":"Aalders M. B.","year":"2026","journal-title":"Journal of Arthroplasty"},{"issue":"1","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"S196","DOI":"10.1016\/j.arth.2025.03.083","article-title":"Patient Personality Influences Early Overall Satisfaction Following Primary Total Hip and Knee Arthroplasty","volume":"40","author":"Ziemba\u2010Davis M.","year":"2025","journal-title":"Journal of Arthroplasty"},{"issue":"5","key":"e_1_2_12_5_1","first-page":"526","article-title":"Depression and Anxiety Are Associated With an Increased Risk of Infection, Revision, and Reoperation Following Total Hip or Knee Arthroplasty","volume":"105","author":"Harmer J. R.","year":"2023","journal-title":"Bone & Joint Journal"},{"issue":"5","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.arth.2025.09.034","article-title":"The Effectiveness of the Patient\u2010Reported Outcomes Measurement Information System Global Health Instrument Mental Health T\u2010Score Versus the Brief Resiliency Scale at Identifying the Potential for Poor Outcomes Following Elective Total Knee and Hip Arthroplasty","volume":"41","author":"Megafu M.","year":"2026","journal-title":"Journal of Arthroplasty"},{"issue":"3","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1080\/17453674.2020.1724674","article-title":"Consensus Statement for Perioperative Care in Total Hip Replacement and Total Knee Replacement Surgery: Enhanced Recovery After Surgery (ERAS(R)) Society Recommendations","volume":"91","author":"Wainwright T. 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C.","year":"2026","journal-title":"Journal of Arthroplasty"},{"issue":"1","key":"e_1_2_12_12_1","first-page":"323","article-title":"Food and Drug Administration (FDA)","volume":"56","author":"Nahler G.","year":"2009","journal-title":"Debra Littlejohn Shinder Thomas W Shinder"},{"issue":"1","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.2106\/JBJS.18.00347","article-title":"Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients: A Prospective, Randomized Controlled Study","volume":"101","author":"Koh I. 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