Anxiety and depression drugs may reduce the need for hip and knee replacement revision

Published March 14, 2017

People who take selective serotonin reuptake inhibitors (SSRIs), which are often prescribed for anxiety and depression, may have a lower risk of revision surgery after total hip or total knee replacement, experts report at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Depression is common in people having hip and knee replacements and is associated with poor outcomes, higher complication rates, longer hospital stays and increased costs.

So a team looked at data from over 20,000 people who had hip and knee replacement operations and found that:

A total of 1,290 (6.4%) of the participants were diagnosed with depression;
SSRIs were administered in 1,563 (7.8%) of participants;
Depression was associated with a doubling of joint infection risk, overall long-term risk of revisions and revisions for aseptic loosening (failure of the bond between the bone and the implant);
People taking SSRIs had a similar rate of joint infections compared with those not taking SSRIs. But people who took them around the time of the operation had almost 60% lower rate of revision surgery.

“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 Dr Daniel Berry, lead study author. “Currently there is no laboratory evidence to explain how SSRIs affect the fixation, or success, of orthopaedic implants.”

The use of SSRIs before and after surgery has been associated with some side effects, including bleeding. However, the study authors conclude that the continuation of SSRIs for people having hip and knee replacement operations does not have detrimental effects on the risk of revision and related complications.

“Depression and psychiatric comorbidity and antidepressant medications are rarely considered when evaluating perioperative risk factors among hip and knee replacement candidates,” Dr Berry says. “Studies such as this raise awareness to better recognize and manage comorbidities and chronic medications in these patients.”