Objective:

To evaluate the association between inflammatory bowel disease (IBD), specifically Crohn's disease (CD) and ulcerative colitis (UC), and the risk of periprosthetic joint infection following total joint arthroplasty.

Approach:

• Study Design: Retrospective claims-database study using the Premier Healthcare Database to identify patients who underwent primary elective total hip or total knee arthroplasty from 2016 to 2023.
• Cohort Selection: Patients younger than 18 years and those who underwent nonelective arthroplasty were excluded. IBD, CD, and UC cohorts were propensity score matched with controls based on age, sex, and comorbidities.
• Outcome Measures: Primary outcome was periprosthetic joint infection within 90 days post-arthroplasty, assessed using ICD-10 codes. Secondary outcomes included renal and respiratory complications, infections, wound complications, hospital readmission, and mortality.
• Statistical Analysis: Multivariable logistic regression was used to adjust for demographics, hospital characteristics, and comorbidities not included in propensity matching.

Key Findings:

• Periprosthetic joint infection occurred in 47 patients with CD vs. 238 matched controls, with a statistically significant increased risk after multivariable adjustment.
• No increased risk of periprosthetic joint infection was found among patients with UC or in the aggregate IBD cohort.
• Patients with IBD had increased risks of acute kidney injury, acute respiratory failure, sepsis, and hospital readmission.

Interpretation:

The study suggests that Crohn's disease is associated with an increased risk of periprosthetic joint infection following total joint arthroplasty, while ulcerative colitis does not show this association.

Limitations:

• The study could not account for disease severity or status, prior colectomy or bowel resection, and medication use.
• The database may be susceptible to coding errors and misclassification of infections.

Conclusion:

Surgeons should consider the increased risk of periprosthetic joint infection in patients with Crohn's disease and optimize these patients prior to arthroplasty surgery.

Sources:

• Arthroplasty Today