Inflammatory Bowel Disease and Adverse Outcomes After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Inflammatory Bowel Disease (IBD) is associated with systemic inflammation and which might influence surgical outcomes. As total joint arthroplasty (TJA) becomes increasingly common in this population as they age, this study aimed to evaluate whether IBD is associated with increased postoperative complications following total hip or knee arthroplasty. We performed a systematic review of studies including patients with and without IBD undergoing TJA. Databases searched included PubMed, Scopus, Web of Science, and Embase through February 24, 2025. Eligible studies included adults with a confirmed diagnosis of IBD who underwent TJA. Meta-analyses were conducted using random-effects models with 95% confidence intervals. Fourteen studies comprising 2,651,318 patients (86,581 with IBD) met inclusion criteria. IBD was significantly associated with increased risks of PJI (OR: 1.47), hospital readmission (OR: 1.39), pneumonia (OR: 1.92), PTE (OR: 1.61), VTE (OR: 1.59), DVT (OR: 1.60), ileus (OR: 5.7), C. difficile infection (OR: 3.3), MI (OR: 2.12), CVA (OR: 2.90), UTI (OR: 2.31), sepsis (OR: 1.83), respiratory failure (OR: 2.17), revision surgery (OR: 1.38), periprosthetic fracture (OR: 1.82), wound (OR: 1.52) and implant complications (OR: 1.62). Length of hospital stay was marginally longer (SMD: 0.06). Mortality and non-home discharge did not differ significantly between groups. Patients with IBD undergoing TJA are at an elevated risk for some postoperative complications, especially infections, thromboembolic events, and revision surgeries. These findings support personalized management strategies in this population. Level IIIa. See Instructions for Authors for a complete description of levels of evidence.