Chemotherapy within 1 year after TJA may increase risk of PJI
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Key takeaways:
- Postoperative chemotherapy was associated with increased risk of joint infection after arthroplasty.
- Patients who received chemotherapy had higher rates of periprosthetic joint infection vs. control patients.
Postoperative chemotherapy may be associated with increased risk of periprosthetic joint infection after total joint arthroplasty, according to published results.
“Chemotherapy suppresses the immune system, rendering patients more vulnerable to infections,” researchers wrote in the study.
Researchers studied data from 17,026 patients in the U.S. who received postoperative chemotherapy within 1 year of total knee (n = 8,558), hip (n = 6,707) or shoulder (n = 1,761) arthroplasty between 2010 and 2022. They also analyzed data from matched cohorts of patients who underwent the same procedures without postoperative chemotherapy.
Researchers found patients who received postoperative chemotherapy had significantly increased rates of PJI at multiple postoperative follow-up timepoints compared with control patients.
Patients who underwent TKA and postoperative chemotherapy had significantly higher rates of PJI at 2 years (OR = 1.59), 3 years (OR = 1.57) and 4 years (OR = 1.40) compared with patients who did not receive postoperative chemotherapy. Patients who had THA and postoperative chemotherapy had significantly higher rates of PJI at 2 years (OR = 2.27), 3 years (OR = 2.32) and 4 years (OR = 2.25) vs. control patients. Additionally, patients who underwent TSA and postoperative chemotherapy had significantly higher rates of PJI at 4 years (OR = 2.20) compared with control patients.
Researchers found no significant differences in rates of all-cause revision between patients who received chemotherapy and control patients.
“[Postoperative] interprofessional follow-up in short-term intervals aimed at early detection and referral can potentially mitigate the risk of PJI and other comorbidity in patients with chemotherapy-related immunosuppression,” the researchers wrote.
Perspective
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The impact of postoperative chemotherapy agents on the development of PJI in patients who have undergone knee, hip or shoulder joint arthroplasty has not been well studied. While it is well known that chemotherapy suppresses the immune system leaving patients susceptible to infection, the impact of chemotherapy administered within the year after arthroplasty on PJI risk is unclear.
This study is a retrospective match-controlled database cohort including more than 17,000 hip, knee and shoulder arthroplasty patients. The study reported an increased risk of PJI in all arthroplasty patients who received chemotherapy within 1 year after arthroplasty at 2, 3 and 4 year follow-up. Despite the increase in PJI incidence, the authors did not find any correlation between cancer patients undergoing chemotherapy and an increased risk for revision arthroplasty. Also, it is important to note that patients receiving pre-arthroplasty chemotherapy, those who had preoperative PJI and postoperative first-year revisions were excluded from the study.
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