IMPACT OF INTERVENTIONS ON DEPRESSION SCORES AND OUTCOMES IN PATIENTS UNDERGOING TOTAL JOINT REPLACEMENT: A SYSTEMATIC REVIEW

Depression is a significant contributor to suboptimal outcomes following total joint arthroplasty (TJA). Patients undergoing TJA with unrecognized or undiagnosed depression are at risk for poorer outcomes. In the appropriate context, such patients may benefit from interventions which improve depression outcomes. As such, we conducted a systematic review of comparative studies to review the available evidence of interventions that impacted depression scores and/or outcomes for patients undergoing TJA. Embase, Ovid Medline, PubMed, and Scopus were reviewed systematically from inception until August 8, 2021. Studies that were relevant for this review included comparative studies between patients that received an intervention prior to or following their primary TJA procedure and a control group that reported on depression outcomes/scores following surgery. The final systematic review consisted of 25 relevant studies. Interventions which improved depression scores during at least one follow up time after TJA included duloxetine, zolpidem, cognitive behavioural therapy (CBT), psychological support, Videoinsight enhancing psychological method, supervised physiotherapy, telephone follow-up, nursing as well as sensory and coping information. In patients that are at risk for undergoing TJA with undiagnosed depression, surgeons should consider incorporating and emphasizing treatment interventions in their peri-operative management and treatment, when applicable, to improve outcomes. The current study directs future research endeavours, highlighting interventions in which further investigation is warranted to investigate their potential role for improving outcomes in patients with diagnosed depression undergoing TJA.