Antidepressant therapy prior to TJA may improve outcomes for patients with depression
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Key takeaways:
- Patients with depression who received antidepressants before TJA had greater outcome improvements vs. untreated patients.
- Patients treated for depression had similar outcomes vs. patients without depression.
Results showed patients with depression who received antidepressants within 6 months prior to total hip or knee arthroplasty had greater improvements in outcomes at 2 years compared with patients with depression who were untreated.
Cade Shadbolt, BA, MA, from the department of surgery at the University of Melbourne and St. Vincent's Hospital Melbourne in Victoria, Australia, and colleagues performed a retrospective study of data from 1,792 TKAs and 1,651 THAs performed between October 2012 and June 2019.
According to the study, Shadbolt and colleagues analyzed WOMAC scores at 1 year and 2 years postoperatively among a cohort of patients without depression, a cohort of patients with depression who were untreated and a cohort of patients with depression who received antidepressant therapy within 6 months prior to surgery.
“Despite being considered a first-line treatment for depression, more than 20% of total hip or knee arthroplasty patients living with this condition were not receiving antidepressants at the time of their procedure,” Shadbolt and colleagues wrote in the study.
Among patients who underwent TKA, 85.9% (n = 1,539) did not have depression, 2.4% (n = 43) had depression and were untreated and 11.7% (n = 210) had depression and received treatment. Among patients who underwent THA, 87.9% (n = 1,451) did not have depression, 3% (n = 50) had depression and were untreated and 9.1% (n = 150) had depression and received treatment.
Overall, Shadbolt and colleagues found patients without depression and patients who received treatment for depression had similar improvements in WOMAC global scores at 1 year and 2 years postoperatively. They noted patients with depression who were untreated had smaller improvements in WOMAC global scores at 2 years postoperatively for both TKA (mean difference = –13.1) and THA (MD = –8.5) compared with patients without depression and patients treated for depression.
Shadbolt and colleagues also found patients with depression who were untreated had smaller improvements in WOMAC pain and WOMAC function scores at 2 years postoperatively compared with patients without depression and patients treated for depression.
“These findings suggest that interventions aiming to improve outcomes among hip or knee arthroplasty patients who have depression should prioritize this patient group,” Shadbolt and colleagues concluded.
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