Does Postoperative Colonoscopy Increase the Risk for Hip and Knee Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis.

Abstract

Periprosthetic joint infections (PJIs) are a serious complication of hip and knee total joint arthroplasty (TJA), leading to increased morbidity, mortality, reoperations, and strain on health care systems. Hematogenous spread from remote sites is a common cause of PJI, prompting guidelines recommending antibiotic prophylaxis for several procedures. However, evidence on whether colonoscopies increase PJI risk post-TJA remains conflicting. To our knowledge, this study is the first systematic review and meta-analysis to assess the risk of PJI following colonoscopy in patients who have TJA. A systematic search of Embase, MEDLINE, CINAHL, and CENTRAL was conducted following predefined criteria. Cohort studies comparing patients who underwent colonoscopy post-TJA with those who did not were included. There were five cohort studies (n = 505,079 patients) that met the inclusion criteria. Data on cohort demographics, colonoscopy timing, and PJI rates were extracted. Random-effects models and the generic inverse variance method were used for meta-analyses. Pooled data showed no significant increase in PJI risk at three months (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.73 to 1.02; P = 0.08), six months (OR = 1.01; 95% CI, 0.81 to 1.27; P = 0.92), nine months (OR = 1.15; 95% CI, 0.88 to 1.51; P = 0.29), or one year (OR = 1.06; 95% CI, 0.86 to 1.31; P = 0.58) postcolonoscopy. Independent risk factors, including diabetes, rheumatoid arthritis, chronic kidney disease, alcohol abuse, tobacco use, pulmonary disease, being a man, and post-traumatic arthritis, significantly increased PJI risk. Postoperative colonoscopies do not significantly increase PJI risk in TJA patients. While postoperative colonoscopies do not appear to pose a significant risk for all patients, identifying and modifying risk factors in those scheduled for colonoscopies may help reduce PJI rates and improve overall outcomes.