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Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Total Joint Arthroplasties (TJAs) are becoming more popular, resulting in a growing economic burden due to potential postoperative complications, with periprosthetic joint infections (PJIs) playing a significant role. The effect of immunosuppression on PJI risk, particularly in cancer patients following chemotherapy, is unknown. The hypothesis of this study investigated whether chemotherapy increases PJI rates in patients who received post-arthroplasty chemotherapy within one year of surgery.

Methods

Data from the M161Ortho dataset of PearlDiver patient records database were utilized using ICD-9, ICD-10, and CPT codes. The cohort includes Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA), and Total Shoulder Arthroplasty (TSA) patients who underwent post-arthroplasty chemotherapy within one year after surgery between 2010 and 2022. Patients in the matched control group did not receive post-arthroplasty chemotherapy. Pre-arthroplasty chemotherapy recipients, PJI, and post-op first year revisions were excluded. Analyses including the linear logistic regression were performed via R statistical software.

Results

Totally, 17,026 patients (8,558 TKAs, 6,707 THAs, and 1,761 TSAs) were included. At two (OR = 1.59, p = 0.034), three (OR = 1.57, p = 0.009), and four (OR = 1.40, p = 0.032) years for TKA, and two (OR = 2.27, p = 0.008), three (OR = 2.32, p < 0.001), and four (OR = 2.25, p0.001) years for THA, PJI rates were significantly higher in the chemotherapy group. TSA patients had a significant rise in PJI after four years (OR = 2.20, p = 0.031).

Conclusions

This study reveals a possible relationship between postoperative chemotherapy and an increased incidence of PJI in patients with arthroplasty. Chemotherapy suppresses the immune system, rendering patients more vulnerable to infections. Additional research is required to confirm these findings.

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Authors and Affiliations

  1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, Baltimore, 2401, MD, USA

    Amir Human Hoveidaei, Ashesh Shrestha, Basilia Onyinyechukwu Nwankwo & Janet D. Conway

  2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Amirhossein Ghaseminejad-Raeini

  3. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Hossein Hosseini-Asl & Armin Hoveidaei

  4. School of Medicine, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran

    Seyed Pouya Taghavi

  5. Department of Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, DC, USA

    Basilia Onyinyechukwu Nwankwo

  6. Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran

    Mohammad Saeid Khonji

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  1. Amir Human Hoveidaei
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Hoveidaei, A.H., Ghaseminejad-Raeini, A., Hosseini-Asl, S.H. et al. Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05307-4

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