Perioperative Antidepressant Use Increases Risk of Opioid Abuse After Total Joint Arthroplasty: study

Dr Supreeth  D R

Perioperative Antidepressant Use Increases Risk of Opioid Abuse After Total Joint Arthroplasty: study

Written By : Dr Supreeth D R Published On 2026-07-28T21:00:00+05:30 | Updated On 28 July 2026 9:00 PM IST

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, Alireza Mirahmadi et al 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.

The authors conducted a retrospective cohort study using the TriNetX Research Network. 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.

The key findings of the study:

• 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.

The authors concluded – “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.”

For further details on the article refer to:

Perioperative Antidepressant Use Increases the Risk of Opioid Abuse After Total Joint Arthroplasty

Alireza Mirahmadi et al

JBJS Open Access 2026:e26.00057.

http://dx.doi.org/10.2106/JBJS.OA.26.00057

PerioperativeAntidepressantOpioid AbuseTotal Joint ArthroplastyJBJS Open Access

Source : JBJS Open Access

Dr Supreeth D R

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

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