COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY

J. Powell; P. Railton; A. Parkar; H. Khong; F. Moradi; C. Smith

doi:10.1302/1358-992X.2020.8.042

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General Orthopaedics

COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY

The Canadian Orthopaedic Association (COA) and The International Combined Orthopaedic Research Societies (ICORS) Meeting, Montreal, Canada, June 2019. Part 3.

J. Powell
P. Railton
A. Parkar
H. Khong
F. Moradi
C. Smith

COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY

Powell J, Railton P, Parkar A, Khong H, Moradi F, Smith C. COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY. Orthop Procs. 2020;102-B(SUPP_8):42-42. doi:10.1302/1358-992X.2020.8.042

Powell, J., et al. “COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY.” Orthopaedic Proceedings, vol. 102-B, no. SUPP_8, 2020, pp. 42-42., https://doi.org/10.1302/1358-992X.2020.8.042

Powell, J., Railton, P., Parkar, A., Khong, H., Moradi, F., & Smith, C. (2020). COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY. Orthopaedic Proceedings, 102-B(SUPP_8), 42-42. https://doi.org/10.1302/1358-992X.2020.8.042

Powell, J., Railton, P., Parkar, A., Khong, H., Moradi, F. and Smith, C. (2020) “COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY.” Orthopaedic Proceedings, 102-B(SUPP_8), pp. 42-42. Available at: https://doi.org/10.1302/1358-992X.2020.8.042

Powell, J., P. Railton, A. Parkar, H. Khong, F. Moradi, and C. Smith. “COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY.” Orthopaedic Proceedings 102-B, no. SUPP_8 (2020): 42-42. https://doi.org/10.1302/1358-992X.2020.8.042

Powell J, Railton P, Parkar A, Khong H, Moradi F, Smith C. COMPARISON OF FUNCTIONAL OUTCOME SCORES IN PATIENTS USING SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) TO PATIENTS WITHOUT SSRI FOLLOWING TOTAL KNEE AND HIP ARTHROPLASTY. Orthop Procs. 2020 Aug 1;102-B(SUPP_8):42-42. https://doi.org/10.1302/1358-992X.2020.8.042

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Abstract

There has been growing interest in the literature regarding evaluation of functional outcomes in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) while suffering from depression and using selective serotonin reuptake inhibitors (SSRI). Previous literature has shown that these patients have lower post-operative functional scores compared to those without SSRI use and with multiple musculoskeletal co-morbidities. This might be the result of potentially suboptimal motivation and participation in the post-operative rehabilitation programs. One recent study from a single center has suggested a reduction in adverse events in patients undergoing arthroplasty while on SSRI. The purpose of this study is to evaluate the post operative functional scores of patients on SSRI and compare them with the patients not prescribed SSRIs.

A retrospective data analysis was performed on patients who had primary TKA and primary THA between 1st June 2014 and 31st May 2017. The patients into two groups. In the first, patients received SSRI for at least one year before the surgery while in group two, patients did not receive SSRI. Outcome measures included Western Ontario and McMaster university osteoarthritis index (WOMAC) and EQ5D5L scores at pre surgery, three months and 12 months post surgery.

Chi-square and t test was used to compare categorical variables and continuous variables respectively. Multivariate linear regression was conducted to compare the change of scores between the two groups and was adjusted for age, gender, and comorbidities. These outcome scores were analyzed separately for TKA and THA.

In the TKA group, there were 1,452 patients using SSRI and 15,981 not using SSR. In the THA group there were 851 patients using SSRIs and 10,102 patients without SSRIs. The baseline WOMAC for TKA patients was 45.6 for the controls and 41.8 for those patients on SSRIs (p < 0 .001). The baseline EQ5DL was 0.53 and 0.46 in the same groups (p < 0 .001). The baseline WOMAC for THA patients was 39.1 for the controls and 36.2 for patients using SSRIs (p < 0 .001). The baseline EQ5DL scores were 0.43 and 0.37respectively, again indicating patients on SSRI therapy had lower baseline scores (p < 0 .001).

There was improvement in WOMAC and EQ5DL scores in all patient groups at 3 months and 12 months. After adjusting for gender, age, comorbidities and baseline score, THA patients not using SSRI showed a greater improvement in their WOMAC and EQ5DL scores than those prescribed SSRIs, WOMAC (p=0.008), EQ5DL (p=0.001). TKA patients showed a similar outcome but only the EQ5DL was statistically significant, WOMAC (p=0.12), EQ5DL (p=0.036).

Our results show that patients on SSRI have lower preoperative WOMAC and EQ5DL scores at baseline when compared to patients not undergoing treatment for depression or anxiety with SSRIs. After arthroplasty, patients using SSRIs show significant improvement at 12 months but the improvement is smaller than the group not using SSRIs.

Email: asifhparkar@gmail.com