Association of preoperative asymptomatic chronic pulmonary inflammation with subsequent periprosthetic joint infection following total joint arthroplasty

Purpose .Periprosthetic joint infection(PJI) is a catastrophic complication after total joint arthroplasty (TJA). Previous studies have shown that there are some factors such as urinary tract infection and dental infection before operation, which can lead to PJI. However, it is not clear whether preoperative asymptomatic chronic pulmonary inflammation will increase the risk of PJI. Methods The data of 1610 patients who underwent TJA in the affiliated Hospital of Xuzhou Medical University from December 2019 to July 2021 were analyzed retrospectively. According to the chest CT report, the patients were divided into pneumonia group and normal group. The patients were followed up for at least one year to compare the incidence of PJI between the pneumonia group and the normal group, and to determine the risk factors of PJI in patients with asymptomatic chronic pulmonary inflammation. Results 1610 patients were followed up, including pneumonia group in 573 cases (35.59%) and normal group in 1037 cases (64.41%). The postoperative PJI rate in the pneumonia group was 2.61%, which was significantly higher than that in the normal group (0.96%). Univariate analysis showed that there were significant differences in chronic pulmonary inflammation (P < 0.010), diabetes (P < 0.015), ESR (P < 0.01), albumin (P < 0.001), C-reactive protein (P < 0.001), hemoglobin (P < 0.001) and lymphocyte percentage (P < 0.023). Multivariate analysis showed that chronic pulmonary inflammation (OR 2.693, P = 0.021) and diabetes mellitus (OR 3.469, P = 0.005) were risk factors of PJI after TJA. Conclusion Patients undergoing elective TJA have a high prevalence of preoperative asymptomatic chronic pulmonary inflammation, and preoperative asymptomatic chronic pulmonary inflammation is a risk factor for PJI after prosthetic arthroplasty. It is recommended that prior to elective TJA surgery, a complete chest CT examination be performed to assess and control chronic inflammation in the lungs, thus effectively reducing the risk of PJI.