The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study.

Meghan M Moran,Daniel D Bohl,Johan Kärrholm,Ali Keshavarzian,D Rick Sumner,D Rick Sumner,Ola Rolfson,Peter Wessman

doi:10.1371/journal.pone.0257310

Meghan M Moran, Daniel D Bohl + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0257310

Copy DOI

Abstract

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestinal tract and is associated with decreased bone mineral density. IBD patients are at higher risk of osteopenia, osteoporosis and fracture compared to non-IBD patients. The impact of IBD on the performance of orthopedic implants has not been well studied. We hypothesized that a history of IBD at the time of primary total hip arthroplasty (THA) would increase the risk of subsequent failure as assessed by revision surgery. A retrospective implant survival analysis was completed using the Swedish Hip Arthroplasty Registry and the Sweden National Patient Register. A total of 150,073 patients undergoing THA for osteoarthritis within an 18-year period were included in the study. THA patients with (n = 2,604) and without (n = 147,469) a history of IBD at the time of THA were compared with primary revision as the main endpoint and adjusted using sex, age category and comorbidity (Elixhauser scores) as covariates. We found that patients with a history of IBD had a relatively higher risk of revision surgery for septic causes while the non-IBD patients had a relatively higher risk of revision for aseptic causes (p = 0.004). Our findings suggest there may be an association between gut health and THA performance.

Highlights

Inflammatory bowel disease (IBD) is a group of chronic inflammatory diseases that attack the intestinal tract, including Crohn’s disease (CD) and ulcerative colitis (UC) [1, 2]
The prevalence of IBD at primary total hip arthroplasty (THA) was slightly higher in females (1.9%) than males (1.5%, Table 1) with a prevalence ratio of 1.26
We found that having IBD led to a greater risk of revision when age, gender and comorbidity index were included in the model

Summary

Introduction

Inflammatory bowel disease (IBD) is a group of chronic inflammatory diseases that attack the intestinal tract, including Crohn’s disease (CD) and ulcerative colitis (UC) [1, 2]. IBD as a diagnosis is increasing world-wide [3]. IBD patients are most commonly diagnosed between 20 and 40 years of age [4], but a second peak of IBD diagnoses has presented in patients >60 years of age [4,5,6]. Older IBD patients account for ~10% of first-flare patients [7] and comprise 10–30% of the IBD population [8].

Methods

Results

Discussion

Conclusion