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

Asgari, Amir-Mohammad; Shaker, Farhad; Pahlevan-Fallahy, Mohammad-Taha; Metanat, Sepehr; Menbari Oskouie, Iman; Vosoughi, Fardis

doi:10.22038/abjs.2026.93977.4239

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

Articles in Press

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 School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

² School of Medicine, 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

Objective: This study aimed to evaluate the link between Selective Serotonin Reuptake Inhibitors (SSRI) consumption and complications or outcomes after total joint arthroplasty (TJA) through a systematic review and meta-analysis.

Methods: A systematic search of four databases found studies comparing outcomes in SSRI users and non-users undergoing TJA. We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and the ROB-2 tool for randomized controlled trials (RCTs). Meta-analyses used a random-effects model, with subgroup and sensitivity analyses to address differences among studies.

Results: Seven studies involving 162,329 TJA cases were included. The meta-analysis showed that SSRI use was linked to a significantly higher risk of needing a transfusion (OR: 1.50, 95% CI: 1.22–1.85, p < 0.0001). The existing literature also connected SSRI use to longer hospital stays and higher rates of readmission. However, there was not enough evidence to make solid conclusions about functional outcomes, quality of life, pain, periprosthetic joint infection (PJI), or revision surgery.

Conclusion: Clinicians should weigh 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.

Keywords

Keywords: total knee arthroplasty

total hip arthroplasty

SSRI

depression

transfusion. Length of stay

systematic review and meta-analysis

Subjects