Inflammatory Bowel Diseases Increase the Risk of Periprosthetic Joint Infection

Abstract

Background: A large body of evidence is emerging to implicate that dysregulation of the gut microbiome (dysbiosis) increases the risk of surgical site infections. Gut dysbiosis is known to occur in patients with inflammatory bowel disease (IBD), allowing for translocation of bacteria across the inflamed and highly permeable intestinal mucosal wall. The null hypothesis was that IBD was not associated with an increased risk of periprosthetic joint infection (PJI) after primary total hip and knee arthroplasty.Methods: A matched cohort study was designed. The primary end point was the occurrence of PJI at 2 years postoperatively. The secondary end points were aseptic revisions at 2 years postoperatively, discharge to a rehabilitation facility, complications up to 30 days after total joint arthroplasty, and readmission up to 90 days after total joint arthroplasty. The International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to identify patients with IBD and the control cohort. A chart review was performed to confirm the diagnosis of IBD. Using our institutional database, 152 patients with IBD were identified and matched (3:1) for age, sex, body mass index, year of surgical procedure, Charlson Comorbidity Index, and involved joint with 456 patients without IBD undergoing total joint arthroplasty. Results:The cumulative incidence of PJI was 4.61% for the patients with IBD compared with 0.88% for the control cohort (p = 0.0024). When univariable Cox regression was performed, a diagnosis of IBD was found to be an independent risk factor for PJI (hazard ratio [HR], 5.44 [95% confidence interval (CI), 1.59 to 18.60]; p = 0.007) and aseptic revisions (HR, 4.02 [95% CI, 1.50 to 10.79]; p = 0.006). The rate of postoperative complications was also higher in patients with IBD.Conclusions: Based on the findings of this study, it appears that patients with IBD are at higher risk for treatment failure due to PJI or aseptic loosening after primary total joint arthroplasty. The exact reason for this finding is not known, but could be related to bacterial translocation from the inflamed intestinal mucosa, the dysregulated inflammatory status of these patients, malnutrition, and potentially other factors. Some of the aseptic failures could be as a result of infection that may have escaped detection and/or recognition.

Inflammatory bowel disease is associated with an increased risk of adverse events in patients undergoing joint arthroplasty

“…Six studies collected data from nationwide administrative databases, 5,18,19,[21][22][23] and two from a single-centre hospital database. 20,24 Five studies reported mixed cohorts of patients suffering from IBD 5,[19][20][21]24 and three included patients with CD only. 18,22,23 One study investigated hip, knee, and shoulder arthroplasty, 21 two investigated hip and knee arthroplasty, 5,24 two investigated total knee arthroplasty only, 22,23 and three investigated total hip arthroplasty only.…”

“…16,17 Recently, several studies have been published investigating the potential impact of IBD on postoperative outcomes in patients undergoing joint arthroplasty. 5,[18][19][20][21][22][23][24][25] These studies produced conflicting results, making it essential to take an evidence-based approach to synthesize the cohort data and draw more concrete conclusions in the context of modern surgical practice. To the best of our knowledge, no systematic review or meta-analysis has been performed to date to evaluate the impact of coexisting IBD on the clinical outcomes in joint arthroplasty patients.…”

Periprosthetic Joint Infection and the Trojan Horse Theory: Examining the Role of Gut Dysbiosis and Epithelial Integrity

“…A disruption of this link can lead to the generation of many known chronic diseases [34e36]. Interestingly, patients with an established chronic gut disease, like Crohn's and Ulcerative Colitis, are at much higher risk of PJI and other infections [37]. The increased risk of these patients for infection was not just related to the administration of immunosuppressive drugs but the actual disease itself [38].…”

Infection of the periprosthetic joint: Current views and forecasts

“…For the best results, this interdisciplinary approach is essential. Regarding the pathophysiology, diagnosis, classification, and therapeutic strategy for PJI, we offer a perspective on current management methods in this review article [4][5][6] . Arthroplasties on the hip and knee are effective elective surgical procedures, with a 10-year survival rate of more than 95%.…”

“…Gram-negative and coagulase-negative staphylococci infections were less common, according to researchers from other studies. Up to 23% of Enterococci species and up to 46.7% of S aureus strains in the USA are vancomycin-resistant [8] . Nearly 9% of Enterococci spp.…”