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.
