The Impact of Celiac Disease on Complication Rates After Total Joint Arthroplasty: A Matched Cohort Study
Matthew W Cole1, Bailey J Ross2, Lacee K Collins1
1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Insights
Celiac disease increases risks for heart attack and fracture after hip replacement surgery. However, complication rates after knee replacement surgery were similar for patients with and without celiac disease.
Area of Science:
- Orthopedic Surgery
- Gastroenterology
- Immunology
Background:
- Inflammatory bowel disease is linked to higher risks after joint replacement.
- The association between celiac disease and postoperative complications after arthroplasty is not well understood.
- This study investigates if celiac disease increases complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Purpose of the Study:
- To determine if celiac disease is associated with increased postoperative complications after primary THA.
- To determine if celiac disease is associated with increased postoperative complications after primary TKA.
Main Methods:
- Retrospective cohort study using the PearlDiver database.
- Matched 1:3 comparison of patients with celiac disease to controls for THA and TKA.
- Analysis of medical and joint complications within 90 days and 2 years, respectively, using multivariable logistic regression.
Main Results:
- After THA, celiac disease patients had higher rates of acute myocardial infarction (OR 1.45) and periprosthetic fractures (OR 2.09).
- Complication rates after TKA were comparable between celiac disease patients and controls (P > .05).
Conclusions:
- Celiac disease is associated with significantly increased risks of acute myocardial infarction and periprosthetic fracture after primary THA.
- Postoperative complication rates following primary TKA are similar for patients with and without celiac disease.
Background:
While many studies have demonstrated increased complication risk after total joint arthroplasty in patients with inflammatory bowel disease, it is unclear if celiac disease is associated with similarly increased risk. The purpose of this study was to analyze if celiac disease is associated with increased postoperative complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods:
A retrospective cohort study was conducted using the PearlDiver database. Patients with celiac disease who underwent THA (n = 1701) and TKA (n = 3515) were matched 1:3 with controls (THA, n = 5103; TKA, n = 10,545) on age, sex, year of arthroplasty, diabetes mellitus, tobacco use, and obesity. Rates of medical complications within 90 days and joint complications including revision arthroplasty, prosthetic joint infection, periprosthetic fracture, and aseptic loosening within 2 years postoperatively were queried. Complication rates were compared for patients with celiac disease vs controls with multivariable logistic regression.
Results:
After primary THA, patients with celiac disease exhibited significantly higher rates of acute myocardial infarction within 90 days (2.7% vs 1.9%; odds ratio 1.45; 95% confidence interval 1.01-2.07) and periprosthetic fractures at 2 years postoperatively (1.1% vs 0.5%; odds ratio 2.09; 95% confidence interval 1.14-3.79) than controls. Following primary TKA, patients with celiac disease exhibited higher but statistically comparable complication rates than controls (all P > .05).
Conclusions:
Celiac disease was associated with significantly higher rates of acute myocardial infarction and periprosthetic fracture after primary THA. Complication rates after primary TKA were similar between the cohorts.
Level Of Evidence:
Level III.
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