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Archives of Orthopaedic and Trauma Surgery

02-05-2024 | Cytostatic Therapy | Hip Arthroplasty

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

Authors: Amir Human Hoveidaei, Amirhossein Ghaseminejad-Raeini, Seyed Hossein Hosseini-Asl, Ashesh Shrestha, Armin Hoveidaei, Seyed Pouya Taghavi, Basilia Onyinyechukwu Nwankwo, Mohammad Saeid Khonji, Janet D. Conway

Published in: Archives of Orthopaedic and Trauma Surgery

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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.
Appendix
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Metadata
Title
Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections
Authors
Amir Human Hoveidaei
Amirhossein Ghaseminejad-Raeini
Seyed Hossein Hosseini-Asl
Ashesh Shrestha
Armin Hoveidaei
Seyed Pouya Taghavi
Basilia Onyinyechukwu Nwankwo
Mohammad Saeid Khonji
Janet D. Conway
Publication date
02-05-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05307-4