{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:17:39Z","timestamp":1787753859999,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Antidepressants are commonly prescribed in patients undergoing total joint arthroplasty. While depression influences recovery, the association between perioperative antidepressant use and opioid-related outcomes remains unclear. Given the opioid crisis, we examined whether antidepressant exposure around surgery is independently associated with postoperative opioid abuse after total knee (TKA) and hip arthroplasty (THA), along with systemic and prosthetic complications over short-term and long-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the TriNetX Research Network (2005-2025). Adults undergoing elective primary TKA or THA were identified using International Classification of Diseases-10\/current procedural terminology codes. Patients with antidepressant prescriptions within 3 months before or after surgery were compared with nonusers. Propensity score matching (1:1) balanced demographics, comorbidities, and concurrent medications. Outcomes included opioid abuse diagnoses, opioid prescribing, systemic complications, and prosthetic failures at 90 days and 5 years. Odds ratios (ORs) with 95% CIs were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After matching, 90-day cohorts included 106,516 TKA patients and 46,227 THA patients per group; 5-year cohorts included 44,251 TKA and 16,019 THA patients per group. Despite modest prescribing differences, antidepressant use was associated with higher opioid-abuse diagnoses. At 90 days: TKA 0.10% vs. 0.02% (OR 4.3) and THA 0.12% vs. 0.02% (OR 5.7). At 5 years: TKA 0.74% vs. 0.12% (OR 6.0) and THA 0.42% vs. 0.09% (OR 4.5). Antidepressant users also had increased systemic and prosthetic complications, including prosthetic joint infection, periprosthetic fracture, and revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Perioperative antidepressant use is independently associated with increased postoperative opioid abuse and higher complication rates after TKA and THA. These findings support preoperative psychiatric screening, medication review, multimodal pain strategies, and closer monitoring to mitigate opioid-related harm in vulnerable arthroplasty patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/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.oa.26.00057","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:00:41Z","timestamp":1775757641000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Antidepressant Use Increases the Risk of Opioid Abuse After Total Joint Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-2692","authenticated-orcid":false,"given":"Alireza","family":"Mirahmadi","sequence":"first","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8233-3436","authenticated-orcid":false,"given":"Jad","family":"Lawand","sequence":"additional","affiliation":[{"name":"UT Medical Branch Galveston, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-358X","authenticated-orcid":false,"given":"Kaveh","family":"Momenzadeh","sequence":"additional","affiliation":[{"name":"Harvard Combined Orthopaedic Residency Program (HCORP), Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2631-6516","authenticated-orcid":false,"given":"Geoffrey","family":"Stoker","sequence":"additional","affiliation":[{"name":"Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1749-1662","authenticated-orcid":false,"given":"Mengnai","family":"Li","sequence":"additional","affiliation":[{"name":"Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-3489","authenticated-orcid":false,"given":"Ara","family":"Nazarian","sequence":"additional","affiliation":[{"name":"Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Mechanical Engineering Department, Boston University, Boston, Massachusetts"},{"name":"Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"issue":"4","key":"R1-20260409","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J Bone Joint Surg."},{"issue":"10","key":"R2-20260409","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1097\/CORR.0000000000001793","article-title":"Is the preoperative use of antidepressants and benzodiazepines associated with opioid and other analgesic use after hip and knee arthroplasty?","volume":"479","author":"Rajam\u00e4ki","year":"2021","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"R3-20260409","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1080\/13607863.2015.1072801","article-title":"Depression and anxiety after total joint replacement among older adults: a meta-analysis","volume":"20","author":"Scott","year":"2016","journal-title":"Aging Ment Health."},{"issue":"4","key":"R4-20260409","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."},{"issue":"8","key":"R5-20260409","doi-asserted-by":"crossref","first-page":"e18813","DOI":"10.1016\/j.heliyon.2023.e18813","article-title":"The association of depression and anxiety with postoperative opioid use following total joint arthroplasty","volume":"9","author":"Diei","year":"2023","journal-title":"Heliyon."},{"issue":"4","key":"R6-20260409","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.arth.2017.10.020","article-title":"Patients with major depressive disorder experience increased perception of pain and opioid consumption following total joint arthroplasty","volume":"33","author":"Etcheson","year":"2018","journal-title":"J Arthroplasty."},{"issue":"3","key":"R7-20260409","doi-asserted-by":"crossref","first-page":"205","DOI":"10.5114\/ait.2023.130661","article-title":"Preoperative anxiolytic and antidepressant medications as risk factors for increased opioid use after total knee arthroplasty: a matched retrospective cohort analysis","volume":"55","author":"Ardon","year":"2023","journal-title":"Anaesthesiol Intensive Ther."},{"issue":"4","key":"R8-20260409","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.artd.2018.07.002","article-title":"The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty","volume":"4","author":"Rubenstein","year":"2018","journal-title":"Arthroplasty Today."},{"issue":"13","key":"R9-20260409","doi-asserted-by":"crossref","first-page":"e737","DOI":"10.5435\/JAAOS-D-24-00743","article-title":"Patients on antidepressants are at an increased risk of adverse events following total knee arthroplasty","volume":"33","author":"Ratnasamy","year":"2024","journal-title":"J Am Acad Orthop Surg."},{"issue":"3","key":"R10-20260409","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.arth.2021.11.013","article-title":"Effects of perioperative selective serotonin reuptake inhibitor use in primary total hip and knee arthroplasty","volume":"37","author":"Bourget-Murray","year":"2022","journal-title":"The J Arthroplasty."}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00057","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:20:03Z","timestamp":1787750403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00057","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}