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Initiating Chemotherapy in Joint Arthroplasty Patients Increases the Risk of Periprosthetic Joint Infections Publisher



Hoveidaei AH1 ; Ghaseminejadraeini A2 ; Hosseiniasl SH3 ; Shrestha A1 ; Hoveidaei A3 ; Taghavi SP4 ; Nwankwo BO1, 5 ; Khonji MS6 ; Conway JD1
Authors
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Authors Affiliations
  1. 1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, Baltimore, 2401, MD, United States
  2. 2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. School of Medicine, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
  5. 5. Department of Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, DC, United States
  6. 6. Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran

Source: Archives of Orthopaedic and Trauma Surgery Published:2024


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. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
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