Inflammatory Bowel Disease and Risk of Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review of the Current Literature.

Abstract

Periprosthetic joint infection (PJI) is a severe complication after total joint arthroplasty (TJA). Inflammatory bowel disease (IBD) may plausibly increase this risk because of chronic systemic inflammation, intestinal barrier dysfunction, malnutrition, and exposure to immunosuppressive therapies; however, the available orthopedic literature is sparse and heterogeneous. This systematic review was revised in accordance with PRISMA 2020 principles and the PRISMA 2020 for Abstracts recommendations. The primary review question was whether patients with IBD undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at increased risk of PJI or septic revision. Cohort and case-control studies reporting arthroplasty-related infectious outcomes in patients with Crohn's disease, ulcerative colitis, or unspecified IBD were eligible for the primary analysis. To ensure the study is scientifically sound, case reports describing nonprosthetic osteomyelitis were excluded from the primary quantitative analysis and evaluated separately using CARE principles as contextual qualitative evidence. No prospective protocol registration was completed before the original review process. The revised review identified two retrospective cohort studies suitable for the primary analysis and two case reports retained in a separate qualitative appendix. The primary analysis included 22,320 arthroplasty patients with IBD studied against much larger non-IBD comparator cohorts. One THA registry study found a higher risk of septic revision in patients with IBD, whereas one TKA database study found higher postoperative PJI odds in both Crohn's disease and ulcerative colitis. Direct quantitative pooling was considered inappropriate because the studies differed in joint type, follow-up duration, and outcome definition. The currently available evidence suggests that IBD may be associated with an increased risk of infection-related failure after arthroplasty, but the certainty of evidence is low to very low because only two retrospective cohort studies directly addressed this question. Future research should use standardized PJI definitions, report disease activity and immunosuppressive treatment in detail, and prospectively evaluate whether the excess risk is related to IBD itself or to modifiable perioperative factors.