The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Selective Serotonin Reuptake Inhibitor Use and Total Joint Arthroplasty Outcomes: A Systematic Review and Meta-Analysis with Emphasis on Transfusion Risk

Document Type : SYSTEMATIC REVIEW

Authors
Amir Mohammad Asgari 1
Farhad Shaker 2
Mohammad Taha Pahlevan Fallahy 2
Sepehr Metanat 3
Iman Menbari Oskouie 4
Fardis Vosoughi 3
1 Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Tehran University of Medical Sciences, Tehran, Iran
3 Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
4 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2026.93977.4239
Abstract
Objectives: This systematic review and meta-analysis aimed to evaluate the association between selective serotonin reuptake inhibitor (SSRI) use and complications and outcomes after total joint arthroplasty (TJA).
Methods: We systematically searched four databases for studies comparing outcomes between SSRI users and non-users undergoing TJA. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the ROB-2 tool for randomized controlled trials (RCTs). Meta-analyses were performed using a random-effects model, with subgroup and sensitivity analyses used to explore between-study heterogeneity.
Results: Eight reports involving 162,329 study-level patient observations were included. SSRI use was associated with a significantly higher risk of transfusion (OR: 1.50, 95% CI: 1.22–1.85, p < 0.0001). Narrative findings also suggested longer hospital stays and higher readmission rates among SSRI users. However, the evidence was insufficient to draw firm conclusions regarding functional outcomes, quality of life, pain, periprosthetic joint infection (PJI), or revision surgery.
Conclusion: Clinicians should balance the quantitatively demonstrated increase in transfusion risk among SSRI users against the potential mental health consequences of abrupt SSRI discontinuation, including withdrawal symptoms or relapse of depression. The evidence remains insufficient to draw firm conclusions regarding functional outcomes, quality of life, pain, PJI, or revision surgery.
Level of evidence: III
Keywords
Depression
Length of stay
SSRI
Systematic review and meta-analysis
Total hip arthroplasty
Total knee arthroplasty
Transfusion
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 10
October 2026
Pages 634-648

  • Receive Date 25 February 2026
  • Revise Date 09 May 2026
  • Accept Date 06 June 2026