Does Inflammatory Bowel Disease Elevate Infection Risk in Total Hip Arthroplasty? Insights from a nationwide study highlighting steroid use as the key determinant

Introduction This study investigated the association between medication status and total hip arthroplasty (THA) complications in patients who have inflammatory bowel disease (IBD), considering varying illness severities. Materials and Methods This retrospective analysis of the National Health Insurance Review and Assessment Service database in South Korea, included patients undergoing unilateral THA between 2012–2022, specifically those diagnosed with IBD. Propensity score matching was used to adjust for baseline characteristics between IBD and non-IBD cohorts, with a matching ratio of 1:10. Results There was a significant difference between the IBD (n = 962) and non-IBD matched groups (n = 9,620) in terms of chronic periprosthetic joint infection (PJI) (2.1 vs 1.3%, P = 0.03) but not with acute PJI or other surgical complications (periprosthetic fracture, dislocation, and aseptic loosening). Medication use itself was not associated with PJI, except for corticosteroid use, significantly associated with PJI among IBD medications (OR: 2.79 [1.03–10.68], P = 0.04). Multivariable analysis indicated a significant increase in PJI risk with corticosteroid use within one year before THA (OR: 3.30 [1.21–10.86], P = 0.01). Patients not using steroids did not exhibit an inherent risk of IBD related complications. Conclusions This nationwide study confirmed that IBD increases the risk of chronic PJI. Preoperative corticosteroid use within the year before arthroplasty significantly increased the risk of PJI, particularly in patients with poorly controlled IBD and acute flares-up. Conversely, well-controlled IBD did not correlate with increased surgical complications. Attention should be directed towards recognizing the risk of steroid use, such as acute flares in cases of uncontrolled IBD, to optimize preoperative treatment for IBD undergoing arthroplasty. Level of Evidence Level III, Prognostic