Patient with the Blues May Bring You Down

Is depression linked with an increased risk for revision?

During 2013-2016, over 8 percent of Americans aged 20 and over had depression.1 Depression is a common chronic mental disorder characterized by mood changes and mental and physical symptoms for over a two week period. Patients effected by depression have a greater functional impairment than many other chronic diseases including diabetes and arthritis.1 With a proper diagnosis, symptoms can be reduced and managed allowing individuals to live a normal life and enjoy every day activities.2

With depression common in the general public, it is likewise collective among patients undergoing any surgery including Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). Previous studies concluded depressed patients who have had THA and TKA experienced worse functional outcomes, increased readmission rates and even greater in-hospital mortality risks.3

A 2018 study published by the Association of Bone and Joint Surgeons also confirmed a depression diagnosis is linked to an increased risk of revision and periprosthetic joint infection among patients undergoing THA and TKA, yet the risk is lower when patients received an antidepressant during the perioperative period.3

For patients with depression who have experienced arthroplasty, taking antidepressants may potentially contribute to better pain management, quicker functional recovery and improved clinical outcomes.3

It is important to note that despite the beneficial effects of antidepressants, specific types of antidepressants can be associated with lower bone mineral density, increased risk in fractures and increased risk of surgical site infections.3

During the preoperative planning period, it is important to examine a patient’s physical health especially factors that increase the risk of complications during surgery such as a high BMI, diabetes and a habit of smoking. These studies suggest that it’s just as essential to evaluate a patient’s previous and current mental state. Understanding a patient’s mental health history, can help you provide an effective perioperative plan than can result in less postoperative complications.

  1. Brody, D. et al. Prevalence of Depression among Adults Aged 20 and Over: United States. U.S. Department of Health and Human Services. 1-7, 2018.
  2. Whooley, M. et al. Managing Depression in Medical Outpatients. The New England Journal of Medicine. 343 (26): 1972-1950, 2000.
  3. Yao, J. et al. Perioperative Inpatient Use of Selective Serotonin Reuptake Inhibitors is Associated with Reduced Risk of THA and TKA Revision. Clinical Orthopedics and Related Research. 1191-1197, 2017.
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