Researchers have found a possible relationship between receiving chemotherapy within a year of a total joint replacement surgery and an increased incidence of infection in the replaced joint.
The analysis by researchers at the Rubin Institute for Advanced Orthopaedics at Sinai Hospital of Baltimore of more than 17 000 patients showed that infections in surgically replaced joints were significantly higher for patients who had undergone subsequent chemotherapy within a year compared with those who had not.
Their findings were published in the Archives of Orthopaedic and Trauma Surgery.
“We became curious about the potential effects of postoperative chemotherapy and the risk of joint infection, after we saw cases in our own joint replacement patients,” said Janet Conway, MD lead author and orthopaedic surgeon at the Rubin Institute for Advanced Orthopaedics who is head of Bone and Joint Infection at Sinai Hospital.
“Early detection of infection is vital, and can spare patients from more invasive treatments, including more surgery to revise the joint replacement. Our research suggests that joint replacement patients who go on to have chemotherapy must be aware of their potential risk for increased infection, and be vigilant for any signs of infection.”
The researchers analysed records in a national patient database for those who had total knee arthroplasty, total hip arthroplasty and total shoulder arthroplasty, who then underwent post-arthroplasty chemotherapy within one year after surgery between 2010 and 2022. They looked at the post-chemotherapy infection rates at two-, three- and four-year intervals.
“Given the number of people receiving total joint replacements each year, and the cost both physically, emotionally and financially for those who develop an infection and may need subsequent treatment, we must understand what factors may increase the risk for postoperative infections,” Conway said.
She said this was probably the first study to comprehensively investigate the potential risk of postoperative joint infection for patients who later receive chemotherapy.
“Future prospective studies focusing on this potential correlation would be crucial, so that essential and preventative measures can be taken into account.”
Study details
Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections
Published in Archives of Orthopaedic & Trauma Surgery on 2 May 2024
Amir Human Hoveidaei, Amirhossein Ghaseminejad-Raeini, Janet Conway et al.
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 utilised 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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