Irritable Bowel Syndrome and Periprosthetic Joint Infection Risk Following Total Hip and Knee Arthroplasty

Past studies have shown that inflammatory bowel disease (IBD) is associated with increased periprosthetic joint infection (PJI) risk, but none have investigated the risk in irritable bowel syndrome (IBS). The purpose of this study was to evaluate the risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients who have IBS.

Patients who underwent THA or TKA were identified using a large national database. Control cohorts of patients who did not have a history of IBS were 1:1 propensity score matched to experimental cohorts of patients who have IBS. A total of 19,102 patients had a history of IBS, of which 7,144 underwent THA and 11,958 underwent TKA. The 2-year PJI and reoperation rates were assessed. Data analyses were repeated in IBD cohorts for internal comparisons. Subgroup analyses stratified IBS cohorts by receipt of IBS prescription medications.

There were no differences in risk of 2-year PJI and reoperations following THA in IBS and IBD cohorts (P > 0.05). Following TKA, IBD was associated with increased risk of 2-year PJI (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.02 to 1.64, P = 0.031), but not reoperations; however, there were no differences among IBS cohorts (P > 0.05). Patients who have IBS and received medication had an elevated risk of 2-year PJI (OR: 1.53, 95% CI: 1.11 to 2.10, P = 0.009) and reoperations (OR: 1.68, 95% CI: 1.14 to 2.46, P = 0.008) following TKA, but not THA.

There were no associations observed between IBS and increased PJI and reoperation rates after THA or TKA. However, IBS patients who were prescribed medications, potentially reflecting greater disease severity, were associated with increased risk of PJI and reoperation following TKA. Further research is needed to clarify the relationship between IBS and PJI.

III.