Invasive Gastrointestinal Endoscopy Following Total Joint Arthroplasty Increases the Risk for Periprosthetic Joint Infection

Preoperative Colonoscopy Is a Risk Factor for Reoperation Following Primary Total Hip Arthroplasty: A Population-Based Study

BACKGROUND

Despite colonoscopy and total hip arthroplasty (THA) being regularly offered to the same age group of patients, there is a sparsity of literature regarding the risk of reoperation following THA and preoperative colonoscopy.

METHODS

We identified patients aged ≥ 18 years who underwent primary THA for osteoarthritis from 2003 to 2020 using administrative databases in Ontario, Canada. We identified patients who underwent colonoscopy up to one year before their THA and matched each colonoscopy patient to 10 controls using propensity score matching. We identified any instances of reoperation related to the primary THA up to five years postoperative. We used Cox Proportional Hazards models to determine the adjusted association between preoperative colonoscopy, the time to reoperation, and the area under the receiver operating curve to identify the optimal cut-off time for preoperative colonoscopy. Between 2003 and 2020, 107,000 patients underwent THA for osteoarthritis in Ontario, Canada, while 1,733 (1.6%) of these received a preoperative colonoscopy. We retained 1,515 colonoscopy patients and matched to 15,150 control patients.

RESULTS

In the colonoscopy group, 69 patients (4.0%) underwent a reoperation within five years postoperatively (versus 2,977 [2.8%] in the control group). The majority of reoperations in both groups were revision THA (colonoscopy: 65 of 69, 94%; control: 2,837 of 2,977, 95%). Undergoing a preoperative colonoscopy up to 12 months before THA was associated with a 1.39 (1.07 to 1.81) increased risk of reoperation within five years postoperative. This risk increased to 1.91 (1.18 to 3.12) if the colonoscopy was done within 83 days of THA.

CONCLUSIONS

Our results indicate that THA patients who undergo a diagnostic colonoscopy up to 12 months preoperatively may have an increased risk of reoperation postoperatively. Furthermore, these data suggest a temporal relationship, where the risk may increase if the colonoscopy is performed closer to the THA.

Impact of Preoperative Colonoscopy on Revision Surgery Risk in Primary Total Knee Arthroplasty: A Comprehensive Population-Based Analysis

BACKGROUND

In the same age group of patients undergoing total knee arthroplasty (TKA), colonoscopies are performed commonly as part of national colorectal cancer screening pathways. Several authors have reported periprosthetic joint infection (PJI) cases after colonoscopy, suggesting transient bacteremia as a potential mechanism for hematogenous seeding. However, the effect of preoperative colonoscopy on the risk of PJI in prospective TKA patients has been minimally studied. This study aimed to investigate the relationship between preoperative colonoscopy and reoperation and revision rates in TKAs performed for osteoarthritis, using data from Ontario's health care databases.

METHODS

This retrospective cohort study identified adults undergoing TKA for osteoarthritis in Ontario, Canada, between 2003 and 2022 through linked databases (CIHI, DAD, and OHIP). Propensity-score matching, Cox proportional hazards regression analysis, Nelson-Aalen curves, and log-log-survival curves were used to evaluate the effect of preoperative colonoscopy on the risk of reoperation and revision arthroplasty due to PJI.

RESULTS

Having a colonoscopy in the 3 months before TKA was associated with a significantly increased risk of TKA-related reoperation and revision TKA (rTKA) (hazard ratio [HR]: 2.20; 95% confidence interval [CI]: 1.05 to 4.63 and HR: 2.59; 95% CI 1.16 to 5.80, respectively). In addition, patients who underwent colonoscopy in the 12 months before TKA had a 1-year rTKA rate of 1.0% compared to 0.5% of patients who did not undergo a colonoscopy in the same time period (P = 0.020). However, having a colonoscopy in the 12 months before TKA was not associated with a significantly increased risk of TKA-related reoperation (HR: 1.43; CI: 0.88 to 2.32) or rTKA (HR: 1.62; CI: 0.94 to 2.78) on multivariate logistic regression analyses.

CONCLUSIONS

This study demonstrated a statistically significant association between having a colonoscopy in the 3 months preceding TKA and increased rates of both TKA-related reoperation and rTKA.

Diagnostic and Invasive Colonoscopies Do Not Increase the Risk of Prosthetic Joint Infection After Reverse Shoulder Arthroplasty

Introduction Reverse shoulder arthroplasty (RSA) is increasingly used to manage various degenerative and traumatic shoulder conditions. Prosthetic joint infection (PJI) remains a rare but serious complication, occurring in approximately 1-4% of cases. Given that colonoscopy can cause transient bacteremia - a potential risk factor for PJI - the current study aimed to determine whether undergoing diagnostic or invasive colonoscopy within one year after RSA is associated with an increased risk of PJI or all-cause revision surgery. Methods A retrospective cohort study was conducted using the PearlDiver All Payer Claims Database (MARINER). Patients who underwent RSA with at least three years of follow-up were identified and stratified into three groups: a control group (no colonoscopy), a diagnostic colonoscopy group, and an invasive colonoscopy group. The colonoscopy occurred within one year after undergoing the index procedure. Demographics, including age and sex, along with comorbidity data (using the Elixhauser Comorbidity Index), were collected. The primary outcomes assessed were the incidence of PJI and the rate of all-cause revision at 3 years postoperatively. Results A total of 1,244 patients in the diagnostic colonoscopy group, 2,973 in the invasive colonoscopy group, and 74,309 in the control group were identified. At three years postoperatively, the incidence of PJI was not significantly different between the diagnostic (3.94% vs. 3.29%, p = 0.20) or invasive (3.8% vs. 3.29%, p = 0.13) groups compared to controls. However, while the rate of all-cause revision in the diagnostic group (7.32% vs. 7.53%, p = 0.78) did not differ significantly from controls, the invasive colonoscopy group approached statistical significance (8.48% vs. 7.53%, p = 0.05) in univariate analysis and was statistically significant in multivariate analysis (OR = 1.63, p ≤ 0.01).  Conclusion This study found that undergoing a diagnostic or invasive colonoscopy within one year after RSA does not increase the risk of PJI at three years postoperatively. However, patients who underwent invasive colonoscopy exhibited a higher rate of all-cause revision, which was statistically significant in multivariate analysis. These findings suggest that routine colonoscopy screening should not be deferred in RSA patients due to infection concerns, but the increased risk of revision following invasive colonoscopy highlights the need for further research to determine potential underlying factors.

Periprosthetic Joint Infection: What's New?

Total joint arthroplasty (TJA) ranks among the most commonly performed orthopedic surgeries, with its annual incidence on the rise globally. Periprosthetic joint infection (PJI) remains a leading cause of arthroplasty failure. This review aims to summarize recent literature updates on the epidemiology, diagnosis, and management of PJI.

Periprosthetic Joint Infection in Patients With Arthroplasty Undergoing Perioperative Colonoscopy

Importance

Periprosthetic joint infection (PJI) is a rare but devastating complication. Most patients undergoing total joint arthroplasty (TJA) also need routine screening colonoscopy, in which transient bacteremia may be a potential source for hematogenous PJI. Patients and surgeons must decide on an optimal time span or sequence for these 2 generally elective procedures, but no such guidelines currently exist.

Objective

To evaluate associations of colonoscopy with the risk of post-TJA PJI for the development of clinical practice recommendations for colonoscopy screening in patients undergoing TJA.

Design, Setting, and Participants

This retrospective cohort study of Military Health System (MHS) beneficiaries older than 45 years who underwent TJA from January 1, 2010, to December 31, 2016, used propensity score matching and logistic regression to evaluate associations of colonoscopy with PJI risk. Statistical analyses were conducted between January and October 2023.

Exposure

Colonoscopy status was defined by Current Procedural Terminology code for diagnostic colonoscopy within 6 months before or 6 months after TJA.

Main Outcomes and Measures

Periprosthetic joint infection status was defined by a PJI International Classification of Diseases code within 1 year after TJA and within 1 year from the post-TJA index colonoscopy date.

Results

Analyses included 243 671 patients (mean [SD] age, 70.4 [10.0] years; 144 083 [59.1%] female) who underwent TJA in the MHS from 2010 to 2016. In the preoperative colonoscopy cohort, 325 patients (2.8%) had PJI within 1 year postoperatively. In the postoperative colonoscopy cohort, 138 patients (1.8%) had PJI within 1 year from the index colonoscopy date. In separate analyses of colonoscopy status within 6 months before and 6 months after TJA, younger age, male sex, and several chronic health conditions (diabetes, kidney disease, and pulmonary disease) were each associated with higher PJI risk. However, no association was found with PJI risk for perioperative colonoscopy preoperatively (adjusted odds ratio, 1.10; 95% CI, 0.98-1.23) or postoperatively (adjusted odds ratio, 0.90; 95% CI, 0.74-1.08).

Conclusions and Relevance

In this large retrospective cohort of patients undergoing TJA, perioperative screening colonoscopy was not associated with PJI and should not be delayed for periprocedural risk. However, health conditions were independently associated with PJI and should be medically optimized.