Short summary

Psychiatric disorders and psychopharmacological drugs have been identified as important risk factors in fast-track hip and knee arthroplasty. The aim of this study is to describe the usage of psychopharmacological drugs in hip and knee arthroplasty patients and investigate how they affect patient-reported outcome and new chronic opioid use after surgery. Furthermore the aim is to investigate the feasibility of perioperative discontinuation of selective serotonin reuptake inhibitors.

Rationale

Fast-track total hip and knee arthroplasty (THA/TKA) and unicompartmental knee arthroplasty (UKA) have evolved during the past 20 years as effective treatments of degenerative joint diseases.

In recent years psychiatric disorders and psychopharmacological treatment have been identified as important risk-factors in fast-track THA/TKA/UKA regarding morbidity, LOS and readmission. Whether the above is due to the psychiatric disorder, the psychopharmacological treatment or a combination is debatable.

In order to investigate the adverse effects of psychopharmacological treatment in THA/TKA/UKA patients, further studies regarding usage, patient-reported outcome measures and risk of new chronic opioid use are needed. Furthermore, a study investigating the feasibility of perioperative discontinuation of serotonin reuptake inhibitors will form the foundation for a future controlled randomized trial investigation the effect of perioperative discontinuation of serotonin reuptake inhibitors.

Description of the cohort

The study population for the descriptive study consists of 400 THA/TKA patients in preoperative treatment with psychopharmacological drugs from Vejle, Farsø, Holstebro, Svenborg, Næstved, Bispebjerg and Hvidovre from January 2021 and forward.

The study population for the registry studies consists of approximately 140,000 THA/TKA/UKA patients operated from 2015 to 2022 from the Danish Hip Arthroplasty Registry (DHR) and the Danish Knee Arthroplasty Registry (DKR) respectively.

The study population for the feasibility study will consist of 200 patients treated with SSRIs/SNRIs planned for THA/TKA at orthopaedic departments in Farsø, Holstebro, Vejle, Svendborg, Næstved, Hvidovre, Bispebjerg and Gentofte.

Data and biological material

Questionaires, DHR, DKR, the Danish Civil Registration System (CPR-registeret), the Danish National Patient Registry (DNPR, Landspatientregisteret) and the Danish National Prescription Registry (NPR, Lægemiddelstatistikregisteret).

Collaborating researchers and departments

Department of Orthopaedic Surgery, Lillebaelt Hospital - Vejle

• Claus Varnum

Section for Surgical Pathophysiology, Copenhagen University Hospital

• Henrik Kehlet
• Christoffer Calov Jørgensen

Psychiatric Center Copenhagen, Rigshospitalet and University of Copenhagen

• Anders Fink-Jensen

Center for Neuropsychiatric Depression Research (CNDR), Mental Health Center Glostrup

Poul Videbech