Research Article| Volume 40, P313-318, January 2023

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Inflammatory bowel disease is associated with increased complications after total knee arthroplasty

Published:December 31, 2022DOI:



      Few studies investigate the influence of inflammatory bowel disease (IBD) on complications following total knee arthroplasty (TKA). Therefore, we compared complications and readmissions frequencies after TKA in patients with Crohn’s disease (CD) and ulcerative colitis (UC) to patients without IBD.


      A large administrative claims database was used to identify patients who underwent primary TKAs from 2010 to 2019 and had a diagnosis of IBD before TKA. Patients were stratified into two groups: those with CD (n = 8,369) and those with UC (n = 11,347). These patients were compared a control of 1.3 million patients without an IBD diagnosis. Chi-square and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were used to compare complication frequencies. Multivariable logistic regression was used to evaluate independent risk factors for 90-day complications.


      Compared to patients without IBD, patients with IBD were associated with higher unadjusted 90-day odds for Clostridium difficile infection (CDI) (CD: OR 2.81 [95% CI 2.17 to 3.63]; p < 0.001; UC: OR 3.01 [95% CI 2.43 to 3.72]; p < 0.001) and two-year periprosthetic joint infection (CD: OR 1.34 [95% CI 1.18 to 1.52]; p < 0.001; UC: OR 1.26 [95% CI 1.13 to 1.41]; p < 0.001). After controlling for risk factors like obesity, tobacco use, and diabetes, both types of IBD were associated with higher 90-day odds for CDI and PJI (p < 0.001 for all).


      IBD is associated with higher 90-day postoperative CDI and PJI compared with patients without IBD. Providers should consider discussing these risks with patients who have a diagnosis of IBD.


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        • Alatab S.
        • Sepanlou S.G.
        • Ikuta K.
        • Vahedi H.
        • Bisignano C.
        • Safiri S.
        • et al.
        The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet Gastroenterol Hepatol. 2020; 5: 17-30
        • Jess T.
        • Loftus E.V.
        • Harmsen W.S.
        • Zinsmeister A.R.
        • Tremaine W.J.
        • Melton L.J.
        • et al.
        Survival and cause specific mortality in patients with inflammatory bowel disease: A long term outcome study in Olmsted County, Minnesota, 1940–2004.
        Gut. 2006; 55: 1248-1254
        • Hendrickson B.A.
        • Gokhale R.
        • Cho J.H.
        Clinical aspects and pathophysiology of inflammatory bowel disease.
        Clin Microbiol Rev. 2002; 15: 79-94
        • Gheita T.A.
        • El Gazzar I.I.
        • El-Fishawy H.S.
        • Aboul-Ezz M.A.
        • Kenawy S.A.
        Involvement of IL-23 in enteropathic arthritis patients with inflammatory bowel disease: preliminary results.
        Clin Rheumatol. 2014; 33: 713-717
        • Kapadia B.H.
        • Issa K.
        • Nagrare N.
        • Pivec R.
        • Banerjee S.
        • Mont M.A.
        Higher revision and complication rates following total hip arthroplasty in patients with inflammatory bowel disease.
        J Arthroplasty. 2014; 29: 596-600
        • Gregory M.H.
        • McKinnon A.
        • Stwalley D.
        • Hippensteel K.J.
        • Loftus E.V.
        • Ciorba M.A.
        • et al.
        Anti-Tumour Necrosis Factor Therapy for Inflammatory Bowel Diseases Do Not Impact Serious Infections after Arthroplasty.
        J Crohn’s Colitis. 2019; 13: 182-188
        • Kim D.J.
        • Tischler E.H.
        • Kong R.M.
        • Nehme F.
        • Dolphin E.J.
        • Ho E.S.
        • et al.
        Crohn’s disease in total knee arthroplasty patients correlates with increased rates of 90-day and overall postoperative complications and readmissions.
        Knee. 2022; 34: 238-245
        • Chisari E.
        • D’Mello D.
        • Sherman M.B.
        • Parvizi J.
        Inflammatory Bowel Diseases Increase the Risk of Periprosthetic Joint Infection.
        J Bone Jt Surg. 2022; 104: 160-165
        • Sinagra E.
        • Orlando A.
        • Scalisi A.
        • Mocciaro F.
        • Criscuoli V.
        • Oliva L.
        • et al.
        Clinical course of severe colitis: A comparison between Crohn’s disease and ulcerative colitis.
        J Biol Regul Homeost Agents. 2018; 32: 415-423
        • PearlDiver
        Research Capabilities. 2022;
        • Ellen Kuenzig M.
        • Manuel D.G.
        • Donelle J.
        • Benchimol E.I.
        Life expectancy and health-adjusted life expectancy in people with inflammatory bowel disease.
        CMAJ. 2020; 192: E1394-E1402
        • Mertelsmann-Voss C.
        • Lyman S.
        • Pan T.J.
        • Goodman S.M.
        • Figgie M.P.
        • Mandl L.A.
        US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis.
        Arthritis Rheumatol (Hoboken, NJ). 2014; 66: 1432-1439
        • Dellinger E.P.
        • Anaya D.A.
        Infectious and immunologic consequences of blood transfusion.
        Crit Care. 2004; 8: 2
        • Opelz G.
        • Sengar D.
        • Mickey M.
        • Terasaki P.
        Effect of blood transfusions on subsequent kidney transplants - PubMed.
        Transplant Proc. 1973; 253
        • Wheatley T.
        • Veitch P.S.
        Effect of blood transfusion on postoperative immunocompetence.
        Br J Anaesth. 1997; 78: 489-492
        • Taneja A.
        • El-Bakoury A.
        • Khong H.
        • Railton P.
        • Sharma R.
        • Johnston K.D.
        • et al.
        Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study.
        J Bone Jt Infect. 2019; 4: 99-105
        • Eriksson C.
        • Henriksson I.
        • Brus O.
        • Zhulina Y.
        • Nyhlin N.
        • Tysk C.
        • et al.
        Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study.
        Aliment Pharmacol Ther. 2018;
        • Bien J.
        • Palagani V.
        • Bozko P.
        The intestinal microbiota dysbiosis and Clostridium difficile infection: is there a relationship with inflammatory bowel disease?.
        Therap Adv Gastroenterol. 2013; 6: 53-68
        • Maltenfort M.G.
        • Rasouli M.R.
        • Morrison T.A.
        • Parvizi J.
        Clostridium difficile colitis in patients undergoing lower-extremity arthroplasty: rare infection with major impact.
        Clin Orthop Relat Res. 2013; 471: 3178-3185
        • Issa M.
        • Vijayapal A.
        • Graham M.B.
        • Beaulieu D.B.
        • Otterson M.F.
        • Lundeen S.
        • et al.
        Impact of Clostridium difficile on inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2007; 5: 345-351
        • Ananthakrishnan A.N.
        • McGinley E.L.
        • Binion D.G.
        Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease.
        Gut. 2008; 57: 205-210
        • Delanois R.E.
        • George N.E.
        • Etcheson J.I.
        • Gwam C.U.
        • Mistry J.B.
        • Mont M.A.
        Risk Factors and Costs Associated With Clostridium difficile Colitis in Patients With Prosthetic Joint Infection Undergoing Revision Total Hip Arthroplasty.
        J Arthroplasty. 2018; 33: 1534-1538