Outcomes Following Total Hip Arthroplasty in Patients Who Have Cutaneous Psoriasis and Psoriatic Arthritis

Cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) are associated with higher risks for soft-tissue infection. However, there is sparse literature examining psoriasis and infectious complications following total hip arthroplasty (THA). Therefore, the purpose of this study was to observe and compare the rates of (1) superficial surgical site infections (superficial SSIs), (2) deep SSIs (deep SSI), and (3) 90-day sepsis rates, and 2-year revision rates following THA in patients who have PsC and PsA compared to patients who did not have psoriasis.

A retrospective database analysis was performed utilizing a large national database. Patients who underwent THA were identified using Current Procedural Terminology codes. In total, 593,013 patients were included, of whom 10,230 patients (1.7%) had PsC and 1,445 patients (0.2%) had PsA. Patients were then classified into three cohorts: (1) PsA, (2) PsC, and (3) patients who do not have either condition (control). Multivariate logistic regressions were utilized to compare the outcomes between study cohorts.

Patients who have PsC had higher 90-day superficial SSI (odds ratio (OR): 2.3; confidence interval (CI): 2.2 to 2.5; P < 0.001), deep SSI (OR: 1.4; 1.2 to 1.5; P < 0.001), wound complications (OR: 1.1; 1.1 to 1.3; P < 0.001), sepsis (OR: 2.8; 2.6 to 3.0; P < 0.001), and aseptic revision (OR: 1.2; CI: 1.2 to 1.3; P < 0.001), while patients who have PsA had higher 90-day superficial SSI (OR: 1.7; CI: 1.4 to 2.0; P < 0.001), sepsis (4.7; 4.3 to 5.2; P < 0.001), and deep SSI (2.9; 2.5 to 3.3; P < 0.001). In addition, both cohorts had a higher 2-year all-cause revision PsC (1.2; 1.1 to 1.2; P < 0.001) and PsA (1.1; 1.0 to 1.3; P < 0.001).

This study showed both manifestations of psoriasis are associated with risks of complications following THA. In particular, both PsC and PsA were associated with higher rates of infections and all-cause revisions. These findings underscore the importance of perisurgical optimizations, including an interdisciplinary team to control flare-ups with enhanced infection prevention measures and patient counseling to reduce complications.