Inflammatory bowel disease is associated with increased complications after total knee arthroplasty

Remily, Ethan A.; Sax, Oliver C.; Douglas, Scott J.; Salib, Christopher G.; Salem, Hytham S; Monárrez, Rubén; Delanois, Ronald E.

doi:10.1016/j.knee.2022.12.010

Cited by 10 publications

(10 citation statements)

References 18 publications

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“…Many studies have shown that patients with a history of IBD are at a higher risk of postoperative complications, but few have investigated complications observed after an arthroplasty procedure. 18,19,24 In recent years, the focus has been on the association of IBD and postoperative THA implant failures. Individual case reports by Passick and Hirsh, 26 Thompson et al, 27 and Ramos Martínez et al 28 described long-term implant failures due to septic causes, most often associated with suspected gastrointestinal fistulas.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] Previous studies have reported that IBD patients have increased rates of postoperative complications. [18][19][20][21][22][23][24] In addition, a recent systematic review reported that elderly patients with IBD are at an increased risk of hospital-and therapy-related complications. 25 Few studies have evaluated whether patients with a history of IBD have worse outcomes following primary THA.…”

Section: Introductionmentioning

confidence: 99%

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The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty

Magruder,

Hidalgo Perea,

Gordon

et al. 2023

HIP International

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Background: Inflammatory bowel disease (IBD) is a systemic inflammatory disorder of the gut. Few studies have evaluated whether patients with a history of IBD have worse outcomes following primary total hip arthroplasty (THA). Therefore, the purpose of this study was to evaluate whether IBD is associated with increased: (1) medical complications; (2) readmissions; and (3) emergency department (ED) visits. Methods: Using a nationwide claims database, patients with IBD undergoing primary THA were identified and matched to a comparison group according to age, sex and the Charlson Comorbidity Index. Outcomes assessed included the development of 90-day medical complications, 90-day re-admissions and 90-day ED visit rates. A p-value <0.0001 was considered statistically significant. Results: Patients with IBD had a greater incidence and odds ratio of total medical complications (31.90% vs. 11.47%; OR 2.89; p < 0.0001) compared with matched controls. IBD patients had significantly higher incidence and odds ratio of developing acute kidney injury (5.46 vs. 1.46%; OR 3.92; p < 0.0001), cerebrovascular accident (1.32 vs. 0.35%; OR 3.79; p < 0.0001), pneumonia (4.02 vs. 1.30%; OR 3.19; p < 0.0001), respiratory failure (1.21 vs. 0.41%; OR 2.94; p < 0.0001), deep vein thrombosis (0.89% vs. 0.30%; OR 2.93; p < 0.0001), and other adverse events. IBD patients also had higher incidence and odds ratio of 90-day re-admissions (4.20% vs. 3.23%; OR 1.31; p < 0.0001) and ED visits (6.56% vs. 3.99%; OR 1.69; p < 0.0001). Conclusions: This study found that patients with IBD are at increased risk of 90-day medical complications, re-admissions, and ED visits. Due to its systemic nature, surgeons operating on these patients should be aware of the disease’s extra-intestinal manifestations, and the potential postoperative risks in IBD patients. Providers should use this investigation when educating patients on potential risks of elective THA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty

Magruder,

Hidalgo Perea,

Gordon

et al. 2023

HIP International

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“…26-1.46 of developing a PJI with relatively similar rates between ulcerative colitis (OR = 1.31) and Crohn's disease (OR = 1.37). 44,45 comparing IBD patients with non-IBD patients and reported a 5.4-fold higher risk of developing PJI. 46 It is suspected that increased gut microbiota dysbiosis (GMD) and gut permeability associated with these inflammatory bowel diseases may lead to uptake of bacteria by immune cells including macrophages and neutrophils that act as a Trojan Horse, therefore disseminating bacteria.…”

Section: Autoimmunity/inflammatory Diseases and Pjimentioning

confidence: 99%

“…Individuals with nonjoint inflammatory diseases also have a higher risk of developing PJI after total knee or hip arthroplasty. Patients with inflammatory bowel disease have an OR of 1.26–1.46 of developing a PJI with relatively similar rates between ulcerative colitis ( OR = 1.31) and Crohn's disease ( OR = 1.37) 44,45 . Chisari et al conducted a retrospective review with 608 patients (1:3 matched) comparing IBD patients with non‐IBD patients and reported a 5.4‐fold higher risk of developing PJI 46 .…”

Section: Autoimmunity/inflammatory Diseases and Pjimentioning

confidence: 99%

Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

Piuzzi,

Klika,

et al. 2023

Journal Orthopaedic Research

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Periprosthetic joint infection is a major complication of total joint arthroplasty. Even with current treatments, failure rates are unacceptably high with a 5‐year mortality rate of 26%. Majority of the literature in the field has focused on development of better biomarkers for diagnostics and treatment strategies including innovate antibiotic delivery systems, anti‐biofilm agents, and bacteriophages. Nevertheless, the role of the immune system, our first line of defense during PJI, is not well understood. Evidence of infection in PJI patients is found within circulation, synovial fluid, and tissue and include numerous cytokines, metabolites, antimicrobial peptides, and soluble receptors that are part of the PJI diagnosis workup. Macrophages, neutrophils, and myeloid derived suppressor cells (MDSCs) are initially recruited into the joint by chemokines and cytokines produced by immune cells and bacteria and are activated by pathogen‐associated molecular patterns (PAMPs). While these cells are efficient killers of planktonic bacteria by phagocytosis, opsonization, degranulation, and recruitment of adaptive immune cells, biofilm‐associated bacteria are troublesome. Biofilm is not only a physical barrier for the immune system but also elicit effector functions. Additionally, bacteria have developed mechanisms to evade the immune system by inactivating effector molecules, promoting killing or anti‐inflammatory effector cell phenotypes, and intracellular persistence and dissemination. Understanding these shortcomings and the mechanisms by which bacteria can subvert the immune system may open new approaches to better prepare our own immune system to combat PJI. Furthermore, preoperative immune system assessment and screening for dysregulation may aid in developing preventative interventions to decrease PJI incidence.This article is protected by copyright. All rights reserved.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Ding

Cheng

et al. 2023

Bone Joint Res

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AimsThe present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD.MethodsA comprehensive literature search was conducted to identify eligible studies reporting postoperative outcomes in IBD patients undergoing joint arthroplasty. The primary outcomes included postoperative complications, while the secondary outcomes included unplanned readmission, length of stay (LOS), joint reoperation/implant revision, and cost of care. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model when heterogeneity was substantial.ResultsEight retrospective studies involving 29,738 patients with IBD were included. Compared with non-IBD controls, patients with IBD were significantly more likely to have overall complications (OR 2.11 (95% CI 1.67 to 2.66), p < 0.001), medical complications (OR 2.15 (95% CI 1.73 to 2.68), p < 0.001), surgical complications (OR 1.43 (95% CI 1.21 to 1.70), p < 0.001), and 90-day readmissions (OR 1.42 (95% CI 1.23 to 1.65), p < 0.001). The presence of IBD was positively associated with the development of venous thromboembolism (OR 1.60 (95% CI 1.30 to 1.97), p < 0.001) and postoperative infection (OR 1.95 (95% CI 1.51 to 2.51), p < 0.001). In addition, patients with IBD tended to experience longer LOS and higher costs of care.ConclusionThe findings suggest that IBD is associated with an increased risk of postoperative complications and readmission after joint arthroplasty, resulting in longer hospital stay and greater financial burden. Surgeons should inform their patients of the possibility of adverse outcomes prior to surgery and make appropriate risk adjustments to minimize potential complications.Cite this article: Bone Joint Res 2023;12(6):362–371.

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Inflammatory bowel disease is associated with increased complications after total knee arthroplasty

Cited by 10 publications

References 18 publications

The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty

The association of inflammatory bowel disease with postoperative complications, re-admissions and emergency department visits following primary total hip arthroplasty

Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

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

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