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Does Symptomatic Benign Prostatic Hyperplasia Increase the Risk of Periprosthetic Joint Infection After Primary Total
Alex Gu1, Amil Agarwal2, Safa C Fassihi2
1Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC; Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.
Background:
Periprosthetic joint infection (PJI) is among the leading causes of failure in total joint arthroplasty. A recently proposed risk factor for PJI is symptomatic benign prostatic hyperplasia (sBPH). This study aims to determine if sBPH is associated with PJI following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods:
Using the Mariner all-payer claims database, 1745 patients with sBPH undergoing primary THA were propensity-matched with 3490 controls, and 3053 patients with sBPH undergoing primary TKA were propensity-matched with 6106 controls. Additionally, the same 1745 patients with sBPH undergoing THA were compared to 317,360 prematched controls, and the same 3053 patients with sBPH undergoing TKA were compared to 557,730 prematched controls. Univariate analysis was conducted using chi-squared or ANOVA where appropriate.
Results:
At two years postoperatively, patients with sBPH were not at significantly increased risk for PJI following primary THA (1.54% vs 1.43%; P = .745) and TKA (1.99% vs 2.14%; P = .642) relative to postmatch controls. Compared to matched controls, THA patients with sBPH had an increased 90-day incidence of anemia (P < .001), blood transfusion (P < .001), and urinary tract infection (UTI; P < .001). Total knee arthroplasty patients with sBPH had an increased 90-day incidence of anemia (P < .001), blood transfusion (P < .001), cellulitis (P = .023), renal failure (P = .030), heart failure (P = .029), and UTI (P < .001) relative to matched controls.
Conclusion:
In primary THA and TKA, sBPH does not appear to be an independent risk factor for PJI within two years postoperatively. However, clinicians should be cognizant of the significantly increased risk for postoperative UTI in this patient population.
Insights
Symptomatic benign prostatic hyperplasia (sBPH) is not a risk factor for periprosthetic joint infection (PJI) after hip or knee replacement. However, patients with sBPH face increased risks for urinary tract infections and other complications.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Urology
Background:
- Periprosthetic joint infection (PJI) is a major cause of total joint arthroplasty failure.
- Symptomatic benign prostatic hyperplasia (sBPH) has been proposed as a potential risk factor for PJI.
Purpose of the Study:
- To investigate the association between sBPH and PJI following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Main Methods:
- Propensity-matched analysis using the Mariner all-payer claims database.
- Comparison of PJI rates between patients with sBPH and matched controls for THA and TKA.
- Univariate analysis to assess statistical significance.
Main Results:
- No significant increase in PJI risk was observed at two years postoperatively for THA or TKA patients with sBPH compared to controls.
- Patients with sBPH undergoing THA or TKA showed a significantly higher incidence of 90-day anemia, blood transfusion, and urinary tract infection (UTI).
- TKA patients with sBPH also had increased risks for cellulitis, renal failure, and heart failure within 90 days.
Conclusions:
- sBPH is not an independent risk factor for PJI within two years after primary THA or TKA.
- Clinicians should be aware of the elevated risk of postoperative UTI in patients with sBPH undergoing joint arthroplasty.
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