Crohn’s disease but not ulcerative colitis may be associated with an increased 90-day risk of periprosthetic joint infection following total joint arthroplasty, according to a retrospective claims-database study.
Investigators used the Premier Healthcare Database to identify patients who underwent primary elective total hip or total knee arthroplasty from 2016 to 2023. Patients younger than 18 years and those who underwent nonelective arthroplasty were excluded. The investigators separately evaluated inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) cohorts.
Each cohort was propensity score matched 1:7 with controls based on age, sex, and comorbidities using nearest-neighbor matching without replacement and a caliper of 0.05. Postmatch balance was assessed using standardized mean differences of less than 0.10.
The primary outcome was periprosthetic joint infection within 90 days following arthroplasty, identified using International Classification of Diseases, 10th Revision. The investigators also assessed 90-day renal and respiratory complications, infections, wound complications, hospital readmission, and mortality. Multivariable logistic regression incorporated patient demographics, hospital characteristics, and comorbidities not included in propensity matching, with models selected using Akaike and Bayesian information criteria.
The investigators included 10,040 patients with IBD matched with 70,203 controls. Separate analyses included 5,474 patients with CD matched with 38,230 controls and 4,555 patients with UC matched with 31,865 controls.
Periprosthetic joint infection occurred in 47 of the patients with CD vs. 238 matched controls. The increased risk remained statistically significant following multivariable adjustment. In contrast, the investigators detected no increased adjusted risk of periprosthetic joint infection among those with UC or in the aggregate IBD cohort.
Adjusted analyses also found increased risks of acute kidney injury, acute respiratory failure, sepsis, and hospital readmission among those with IBD. The patients with CD had increased risks of acute kidney injury, sepsis, any postoperative infection, and hospital readmission following adjustment; whereas patients with UC had an increased risk of hospital readmission.
The investigators noted that they could not account for disease severity or status; prior colectomy or bowel resection; use of corticosteroids, 5-aminosalicylates, immunomodulators, or biologics; or reliable measures of nutritional status and malabsorption. Periprosthetic joint infection risk was not assessed separately by joint.
The database captured about 25% of US inpatient admissions and was susceptible to coding errors. The investigators noted that administrative coding used to identify periprosthetic joint infection may not have fully distinguished deep infections requiring surgical intervention from more superficial postoperative infections managed nonoperatively, creating the potential for misclassification.
“As such, surgeons should carefully consider the increased risk of [periprosthetic joint infection] in patients who have CD and ensure these patients are appropriately optimized prior to arthroplasty surgery in order to minimize infectious complications,” wrote lead study author McKenzie W. Culler, MD, of the Department of Orthopaedic Surgery at the Keck School of Medicine at the University of Southern California, Los Angeles, and colleagues.
Nathanael D. Heckmann, MD, disclosed financial relationships with Corin USA, Intellijoint Surgical, MicroPort Orthopedics, and Zimmer; as well as appointments with American Academy of Orthopaedic Surgeons, American Joint Replacement Registry, American Association of Hip and Knee Surgeons, and Knee Society. Jay R. Lieberman, MD, disclosed financial relationships with DePuy, BD Surgiphor, Hip Innovations Technologies, and Saunders/Mosby-Elsevier; as well as appointments with American Academy of Orthopaedic Surgeons, Hip Society, Musculoskeletal Transplant Foundation, and Western Orthopaedic Association. The study authors reported no other conflicts of interest.
Source: Arthroplasty Today
