Do Infections Start in the Gut? Patients with Inflammatory Bowel Disease Have a Higher Risk of Periprosthetic Joint Infection after Surgery - European Medical Journal

Do Infections Start in the Gut? Patients with Inflammatory Bowel Disease Have a Higher Risk of Periprosthetic Joint Infection after Surgery

2 Mins
Microbiology & Infectious Diseases
EMJ Microbiology 2.1 2021 Feature Image
*Emanuele Chisari, Darren D’Mello, Matthew B. Sherman, Javad Parvizi

Parvizi has received royalties/licenses from Corantech, Parvizi Surgical Innovation, and Zimmer; consultancy fees from Corantech and Ethicon; and participated on advisory boards for Cardinal Health and MicrogenDx. Chisari, D’Mello, and Sherman have declared no conflicts of interest.


Mathias and Almusallam contributed equally to this study. This work was partly funded through a BBSRC grant: China/UK/Thailand Program on Poultry Biosafety for Salmonella, E. coli and Campylobacter (CUT-SEC). Grant Reference: BB/R012776/1.

EMJ Microbiol Infect Dis. Year Published: 2021. 2[1]:37-38. Abstract Review No. AR8..
Infections, inflammatory bowel disease (IBD), periprosthetic joint infection (PJI), surgery, surgical infections, total joint arthroplasty (TJA).

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


A large body of evidence is emerging to implicate that dysregulation of the gut microbiome (dysbiosis) increases the risk of surgical site infections. Gut dysbiosis is known to occur in patients with inflammatory bowel disease (IBD), allowing for translocation of bacteria across the inflamed and highly permeable intestinal mucosal wall. The null hypothesis was that IBD was not associated with increased risk of periprosthetic joint infection (PJI) after primary total hip and knee arthroplasty.


A matched cohort study was designed. The primary endpoint was occurrence of PJI at 2 years. Secondary endpoints were aseptic revisions, as well as discharge to rehabilitation facility, complications up to 30 days, and readmission up to 90 days after total joint arthroplasty (TJA). ICD-9 and -10 codes were used to identify patients with IBD and the control cohort. A chart review was performed to confirm diagnosis of IBD. Using the institutional database, 152 patients with IBD were identified and matched (3:1) for age, sex, BMI, year of surgery, Charlson Comorbidity Index (CCI), and affected joint with 462 patients without IBD undergoing TJA.


The cumulative incidence of PJI was 4.55% among patients with IBD versus 1.32% among the control cohort (p=0.024). When univariable Cox regression was performed, a diagnosis of IBD was found to be an independent risk factor for PJI (hazard ratio: 3.61; 95% confidence interval: 1.21–10.74; p=0.021) and aseptic revisions (hazard ratio: 3.48; 95% confidence interval: 1.34–9.01; p=0.010). The rate of post-operative complications was also higher in patients with IBD.


Based on the findings of this study, it appears that patients with IBD are at higher risk for failure due to PJI or aseptic loosening after primary TJA. The exact reason for this finding is not known but could be related to the bacterial translocation from the inflamed intestinal mucosa, the dysregulated inflammatory status of these patients, malnutrition, and potentially other factors. Some of the so-called aseptic failures could be as a result of infection that may have escaped detection and/or recognition.

Level of Evidence: Level II.

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