Inflammatory Bowel Disease and Periprosthetic Joint Infection Following Total Joint Arthroplasty: Crohn’s Disease and Ulcerative Colitis Associated With Varying Risk

Introduction The risk of periprosthetic joint infection (PJI) in patients with inflammatory bowel disease (IBD) who undergo total joint arthroplasty (TJA) remains unclear as reports in the literature are inconclusive. This study sought to clarify the relationship between IBD and PJI risk after TJA. Methods An all-payer claims database was used to identify patients who underwent primary elective TJA between 2016 and 2023. Patients who had a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified. Propensity score matching (1:7) was performed for the UC, CD, and aggregate IBD cohorts based on age, sex, and comorbidities. Ninety-day PJI risk was assessed using multivariable regression. Results In total, 10,040 patients with IBD were identified and matched to 70,203 controls. Separately, 5474 CD patients were matched to 38,230 controls, and 4555 UC patients were matched to 31,865 controls. PJI rates were similar between the IBD and control cohorts (0.71% vs 0.61%; P = .245). However, patients with CD had a significantly higher PJI rate compared to controls (0.86% vs 0.62%; P = .043), while patients with UC had a similar rate compared to controls (0.53% vs 0.64%; P = .365). After adjusting for confounders, CD was associated with an increased risk of PJI (adjusted odds ratio: 1.38; 95% confidence interval: 1.01-1.89; P = .046). No increased risk was detected in the UC or combined IBD cohorts. Discussion CD is independently associated with increased PJI risk following TJA, while UC is not. This distinction may account for inconsistencies in the literature evaluating IBD as a risk factor for PJI.