{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:50:06Z","timestamp":1791510606563,"version":"4.3.4"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Major anxiety symptoms are commonly observed in patients undergoing total hip arthroplasty (THA); these symptoms exacerbate pain and compromise hip recovery. Olanzapine demonstrates clinically meaningful efficacy in reducing anxiety; thus, we investigated its anxiolytic effect and benefits for enhancing recovery in these high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We prospectively enrolled 135 patients who were scheduled for primary THA at our institution between April 2024 and March 2025 and who scored at least 40 points on the State-Trait Anxiety Inventory-State (STAI-S) before surgery. Patients randomly received oral olanzapine (2.5 mg), alprazolam (0.4 mg), or a placebo once nightly for 5 days beginning on the day of admission. The 3 groups (45 patients in the olanzapine group, 45 in the alprazolam group, and 44 in the placebo group after 1 patient was lost to follow-up) were compared postoperatively in terms of the STAI-S score, Pittsburgh Sleep Quality Index (PSQI), visual analog scale (VAS) pain score, opioid consumption, and functional recovery of the hip. Adverse events related to drugs and surgery were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Compared with placebo and alprazolam, olanzapine was associated with significantly lower STAI-S scores on postoperative days (PODs) 1 and 3, significantly lower resting VAS pain scores on PODs 1 to 3, and significantly lower incidence of postoperative nausea and vomiting. The olanzapine group and the alprazolam group demonstrated significantly better sleep quality based on the PSQI on POD 3 compared with the placebo group. Moreover, the olanzapine group had lower opioid consumption on PODs 1 to 3 than the placebo group. Patients in the olanzapine group exhibited better Harris hip scores and Hip Disability and Osteoarthritis Outcome Scores. The 3 groups did not significantly differ in terms of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Perioperative low-dose olanzapine may be an effective option for reducing anxiety levels, sleep disorders, and postoperative nausea and vomiting, mitigating postoperative pain and enhancing hip recovery among patients with anxiety symptoms undergoing THA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01236","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T18:00:38Z","timestamp":1775844038000},"page":"1173-1180","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Significant Anxiolytic Effect and Enhanced Recovery Benefits of Perioperative Low-Dose Olanzapine in Patients with Anxiety Undergoing THA"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4859-6362","authenticated-orcid":false,"given":"Boyi","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2753-9861","authenticated-orcid":false,"given":"Jiaxuan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5214-9809","authenticated-orcid":false,"given":"Yahao","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-2259","authenticated-orcid":false,"given":"Yongrui","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8088-2688","authenticated-orcid":false,"given":"Zichuan","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3890-0784","authenticated-orcid":false,"given":"Zeyu","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9037-4756","authenticated-orcid":false,"given":"Zongke","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, West China Hospital\/West China School of Medicine, Sichuan University, Chengdu, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"7S","key":"bib1-20261009","doi-asserted-by":"crossref","first-page":"S498","DOI":"10.1016\/j.arth.2022.02.042","article-title":"Dissatisfaction after total hip arthroplasty associated with preoperative patient-reported outcome phenotypes","volume":"37","author":"Orr","year":"2022","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib2-20261009","doi-asserted-by":"crossref","first-page":"132","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","year":"2026","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib3-20261009","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1302\/0301-620X.101B7.BJJ-2018-1309.R1","article-title":"Pain catastrophizing, anxiety, and depression in hip pathology","volume":"101-B","author":"Hampton","year":"2019","journal-title":"Bone Joint J."},{"issue":"12","key":"bib4-20261009","first-page":"CD009861","article-title":"Melatonin for preoperative and postoperative anxiety in adults","volume":"12","author":"Madsen","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"bib5-20261009","doi-asserted-by":"crossref","first-page":"110528","DOI":"10.1016\/j.jpsychores.2021.110528","article-title":"A multicenter survey of perioperative anxiety in China: pre- and postoperative associations","volume":"147","author":"Li","year":"2021","journal-title":"J Psychosom Res."},{"issue":"8","key":"bib6-20261009","doi-asserted-by":"crossref","first-page":"e2329310","DOI":"10.1001\/jamanetworkopen.2023.29310","article-title":"Augmented reality for perioperative anxiety in patients undergoing surgery: a randomized clinical trial","volume":"6","author":"Rizzo","year":"2023","journal-title":"JAMA Netw Open."},{"issue":"1","key":"bib7-20261009","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40001-018-0339-4","article-title":"Evaluation of preoperative anxiety and fear of anesthesia using APAIS score","volume":"23","author":"Celik","year":"2018","journal-title":"Eur J Med Res."},{"issue":"10","key":"bib8-20261009","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S0025-6196(11)63995-5","article-title":"Patients\u2019 concerns prior to undergoing total hip and total knee arthroplasty","volume":"74","author":"Trousdale","year":"1999","journal-title":"Mayo Clin Proc."},{"issue":"12","key":"bib9-20261009","doi-asserted-by":"crossref","first-page":"2926","DOI":"10.1007\/s11999-017-5244-6","article-title":"Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty?","volume":"475","author":"Kurtz","year":"2017","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib10-20261009","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.joca.2014.12.022","article-title":"Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink","volume":"23","author":"Culliford","year":"2015","journal-title":"Osteoarthritis Cartilage."},{"issue":"6","key":"bib11-20261009","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s40263-014-0162-6","article-title":"Role of atypical antipsychotics in the treatment of generalized anxiety disorder","volume":"28","author":"Hershenberg","year":"2014","journal-title":"CNS Drugs."},{"issue":"2","key":"bib12-20261009","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1001\/jamapsychiatry.2014.2190","article-title":"Why are benzodiazepines not yet controlled substances?","volume":"72","author":"Moore","year":"2015","journal-title":"JAMA Psychiatry."},{"issue":"3","key":"bib13-20261009","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s002130050834","article-title":"The in vivo effects of olanzapine and other antipsychotic agents on receptor occupancy and antagonism of dopamine D1, D2, D3, 5HT2A and muscarinic receptors","volume":"141","author":"Zhang","year":"1999","journal-title":"Psychopharmacology (Berl)."},{"issue":"6","key":"bib14-20261009","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/AJP.0000000000000567","article-title":"A systematic review of atypical antipsychotics in chronic pain management: olanzapine demonstrates potential in central sensitization, fibromyalgia, and headache\/migraine","volume":"34","author":"Jimenez","year":"2018","journal-title":"Clin J Pain."},{"issue":"10","key":"bib15-20261009","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1111\/anae.16081","article-title":"Olanzapine as an add-on, pre-operative anti-emetic drug for postoperative nausea or vomiting: a randomised controlled trial","volume":"78","author":"Grigio","year":"2023","journal-title":"Anaesthesia."},{"issue":"5","key":"bib16-20261009","first-page":"617","article-title":"Adverse effects of antipsychotic medications","volume":"81","author":"Muench","year":"2010","journal-title":"Am Fam Physician."},{"key":"bib17-20261009","doi-asserted-by":"crossref","first-page":"711940","DOI":"10.3389\/fphar.2021.711940","article-title":"Genetic polymorphisms associated with the pharmacokinetics, pharmacodynamics and adverse effects of olanzapine, aripiprazole and risperidone","volume":"12","author":"Soria-Chacartegui","year":"2021","journal-title":"Front Pharmacol."},{"issue":"11","key":"bib18-20261009","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.23736\/S0375-9393.18.12520-X","article-title":"Preoperative anxiety and implications on postoperative recovery: what can we do to change our history","volume":"84","author":"Stamenkovic","year":"2018","journal-title":"Minerva Anestesiol."},{"issue":"0 11","key":"bib19-20261009","first-page":"S467","article-title":"Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A)","volume":"63","author":"Julian","year":"2011","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"3","key":"bib20-20261009","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.arth.2022.10.007","article-title":"Significant analgesic benefits of perioperative duloxetine in patients who have depressive symptoms undergoing total hip arthroplasty: a randomized controlled trial","volume":"38","author":"Ding","year":"2023","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib21-20261009","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1186\/s13018-019-1446-9","article-title":"Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study","volume":"14","author":"Luo","year":"2019","journal-title":"J Orthop Surg Res."},{"issue":"1","key":"bib22-20261009","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/17453674.2019.1683790","article-title":"Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"91","author":"Wainwright","year":"2020","journal-title":"Acta Orthop."},{"issue":"2","key":"bib23-20261009","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1345\/aph.1H421","article-title":"Opioid conversions in acute care","volume":"41","author":"Patanwala","year":"2007","journal-title":"Ann Pharmacother."},{"issue":"2","key":"bib24-20261009","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/dsu.12047","article-title":"Music reduces patient anxiety during Mohs surgery: an open-label randomized controlled trial","volume":"39","author":"Vachiramon","year":"2013","journal-title":"Dermatol Surg."},{"issue":"1","key":"bib25-20261009","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12871-021-01271-3","article-title":"Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study","volume":"21","author":"Ma","year":"2021","journal-title":"BMC Anesthesiol."},{"issue":"5","key":"bib26-20261009","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1302\/0301-620X.105B5.BJJ-2022-1123.R1","article-title":"Depression and anxiety are associated with an increased risk of infection, revision, and reoperation following total hip or knee arthroplasty","volume":"105-B","author":"Harmer","year":"2023","journal-title":"Bone Joint J."},{"issue":"11","key":"bib27-20261009","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1089\/jpm.2016.0220","article-title":"Olanzapine for nausea, delirium, anxiety, insomnia, and cachexia #315","volume":"19","author":"Felton","year":"2016","journal-title":"J Palliat Med."},{"issue":"8","key":"bib28-20261009","doi-asserted-by":"crossref","first-page":"630","DOI":"10.2174\/1389557515666150219125030","article-title":"Benzo- and thienobenzo- diazepines: multi-target drugs for CNS disorders","volume":"15","author":"Mendon\u00e7a J\u00fanior","year":"2015","journal-title":"Mini Rev Med Chem."},{"issue":"12","key":"bib29-20261009","first-page":"CD008120","article-title":"Second-generation antipsychotics for anxiety disorders","author":"Depping","year":"2010","journal-title":"Cochrane Database Syst Rev."},{"issue":"1","key":"bib30-20261009","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11864-020-00804-1","article-title":"The benefits of olanzapine in palliating symptoms","volume":"22","author":"Davis","year":"2020","journal-title":"Curr Treat Options Oncol."},{"issue":"1","key":"bib31-20261009","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0920-9964(98)00146-7","article-title":"Antagonism by olanzapine of dopamine D1, serotonin2, muscarinic, histamine H1 and alpha 1-adrenergic receptors in vitro","volume":"37","author":"Bymaster","year":"1999","journal-title":"Schizophr Res."},{"issue":"2","key":"bib32-20261009","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/acps.70051","article-title":"Comparative efficacy and tolerability of multiple antipsychotics across varying doses for neuropsychiatric symptoms of dementia including Alzheimer\u2019s disease: a dose-response model-based network meta-analysis","volume":"153","author":"Terao","year":"2026","journal-title":"Acta Psychiatr Scand."},{"issue":"4","key":"bib33-20261009","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S0885-3924(02)00378-0","article-title":"Olanzapine in the management of cancer pain","volume":"23","author":"Khojainova","year":"2002","journal-title":"J Pain Symptom Manage."},{"issue":"7","key":"bib34-20261009","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.jpsychires.2012.04.004","article-title":"Pilot study of the efficacy of double-blind, placebo-controlled one-week olanzapine stabilization therapy in heterogeneous symptomatic bipolar disorder patients","volume":"46","author":"Srivastava","year":"2012","journal-title":"J Psychiatr Res."},{"issue":"2","key":"bib35-20261009","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/FTD.0000000000000695","article-title":"Therapeutic drug monitoring of olanzapine and cytochrome P450 genotyping in nonsmoking subjects","volume":"42","author":"Miroshnichenko","year":"2020","journal-title":"Ther Drug Monit."},{"key":"bib36-20261009","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.smrv.2016.05.002","article-title":"The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia","volume":"33","author":"Monti","year":"2017","journal-title":"Sleep Med Rev."},{"issue":"5","key":"bib37-20261009","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/S0006-3223(99)00273-5","article-title":"Olanzapine increases slow-wave sleep: evidence for blockade of central 5-HT(2C) receptors in vivo","volume":"47","author":"Sharpley","year":"2000","journal-title":"Biol Psychiatry."},{"issue":"4","key":"bib38-20261009","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s00213-006-0633-7","article-title":"Effects of olanzapine, risperidone and haloperidol on sleep after a single oral morning dose in healthy volunteers","volume":"190","author":"Gim\u00e9nez","year":"2007","journal-title":"Psychopharmacology (Berl)."},{"issue":"3","key":"bib39-20261009","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1054\/jpai.2003.438","article-title":"Report of three case studies with olanzapine for chronic pain","volume":"4","author":"Gorski","year":"2003","journal-title":"J Pain."},{"issue":"1","key":"bib40-20261009","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0091-3057(99)00107-0","article-title":"The atypical neuroleptics clozapine and olanzapine differ regarding their antinociceptive mechanisms and potency","volume":"64","author":"Schreiber","year":"1999","journal-title":"Pharmacol Biochem Behav."},{"issue":"6","key":"bib41-20261009","doi-asserted-by":"crossref","first-page":"566","DOI":"10.4103\/ija.ija_1162_23","article-title":"Olanzapine versus standard antiemetic prophylaxis for the prevention of post-discharge nausea and vomiting after propofol-based general anaesthesia: a randomised controlled trial","volume":"68","author":"Deb","year":"2024","journal-title":"Indian J Anaesth."},{"issue":"6","key":"bib42-20261009","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1097\/ALN.0000000000003286","article-title":"Olanzapine for the prevention of postdischarge nausea and vomiting after ambulatory surgery: a randomized controlled trial","volume":"132","author":"Hyman","year":"2020","journal-title":"Anesthesiology."},{"key":"bib43-20261009","first-page":"17504589241308820","article-title":"Effect of different doses of oral olanzapine to prevent postoperative nausea and vomiting after laparoscopic surgery in high-risk patients: a randomised controlled trial","volume":"26","author":"Abdel-Wahab","year":"2025","journal-title":"J Perioper Pract."},{"key":"bib44-20261009","doi-asserted-by":"crossref","first-page":"20420986241244593","DOI":"10.1177\/20420986241244593","article-title":"Olanzapine for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a randomized controlled trial","volume":"15","author":"Chen","year":"2024","journal-title":"Ther Adv Drug Saf."},{"issue":"5","key":"bib45-20261009","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S0033-3182(10)70723-4","article-title":"Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial","volume":"51","author":"Larsen","year":"2010","journal-title":"Psychosomatics."},{"issue":"1","key":"bib46-20261009","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.arth.2020.07.071","article-title":"The relationship between psychological aspects and trajectories of symptoms in total knee arthroplasty and total hip arthroplasty","volume":"36","author":"Hafkamp","year":"2021","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib47-20261009","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/j.apmr.2009.06.012","article-title":"Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis","volume":"90","author":"Scopaz","year":"2009","journal-title":"Arch Phys Med Rehabil."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:00:22Z","timestamp":1791507622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01236"}},"subtitle":["A Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":47,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01236","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}