Association between antibiotic history and revision risk in arthroplasty outcomes

Recent evidence has shown a connection between the gut microbiome (GM) and joint health, with changes in the microbial community (dysbiosis) leading to joint degeneration, prosthesis loosening, and joint infection. A leading cause of dysbiosis is excessive antibiotic use. However, the relationship between antibiotics and post-operative joint recovery is largely unexplored. This study aims to investigate whether a history of antibiotic use is associated with a higher odds of revision following primary total knee arthroplasty (TKA) or total hip arthroplasty (THA.).

This retrospective study analyzed the records of patients who underwent a primary TKA or THA from January 2014 to January 2024 at a quaternary-care medical center. Demographic information, comorbidities, lifetime antibiotic prescriptions excluding perioperative prophylaxis, post-operative infection status, and reoperation data were collected. Controlling for age, sex, BMI, race, prior prosthetic joint infections, and Charlson Comorbidity Index, a multivariable logistic regression analysis was conducted.

A total of 2457 patients were analyzed. Among patients undergoing TKA, any history of antibiotics was associated with revision (OR 2.04, 95% CI 1.19-3.58, p = 0.011). The THA cohort had similar odds of revision (OR 2.51, 95% CI 1.25-5.18, p = 0.011). In a model limited to revisions caused by infection, antibiotic use on a binary scale was not a significant predictor (OR 1.63, 95% CI 0.735-3.70 p = 0.232). However, on a continuous scale, the odds of revision increased by 1% for each additional antibiotic taken for infection-related revisions (OR 1.01, 95% CI 1.000-1.03 P = 0.046).

Our study demonstrates that antibiotic use is associated with higher odds of revision following TKA and THA. These preliminary findings contextualize the gut-joint axis, adding a unique variable to this relationship. Future studies may build on this hypothesis-generating information to further understand the interplay between the GM and joint health.