The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study

Abstract

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestinal tract and is associated with decreased bone mineral density. IBD patients are at higher risk of osteopenia, osteoporosis and fracture compared to non-IBD patients. The impact of IBD on the performance of orthopedic implants has not been well studied. We hypothesized that a history of IBD at the time of primary total hip arthroplasty (THA) would increase the risk of subsequent failure as assessed by revision surgery. A retrospective implant survival analysis was completed using the Swedish Hip Arthroplasty Registry and the Sweden National Patient Register. A total of 150,073 patients undergoing THA for osteoarthritis within an 18-year period were included in the study. THA patients with (n = 2,604) and without (n = 147,469) a history of IBD at the time of THA were compared with primary revision as the main endpoint and adjusted using sex, age category and comorbidity (Elixhauser scores) as covariates. We found that patients with a history of IBD had a relatively higher risk of revision surgery for septic causes while the non-IBD patients had a relatively higher risk of revision for aseptic causes (p = 0.004). Our findings suggest there may be an association between gut health and THA performance.

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

“…The included studies were all conducted in the USA. 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.…”

“…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.…”

Effect of circadian clock and claudin regulations on inulin-induced calcium absorption in the mouse intestinal tract

“…As mentioned at the beginning, osteopenia and osteoporosis are prevalent in IBD patients [ 3 ]. Interestingly, high expression levels of claudin-2 can be found in IBD (both Crohn’s disease and ulcerative colitis) [ 56 ].…”

“…When the blood calcium level falls below the acceptable range, the parathyroid hormone level increases, bone resorption accelerates, and calcium is eluted from bone into the blood to maintain the blood calcium level. Therefore, if low calcium levels continue, bone mass will decrease, leading to the development of osteoporosis [ 2 ], which IBD patients are at higher risk of developing in addition to osteopenia and fracture compared with non-IBD patients [ 3 ]. Thus, proper intake of calcium is very important for maintaining a healthy condition.…”