Preoperative Pneumonia and Its Association With Periprosthetic Joint Infection and Postoperative Complications After Total Hip and Knee Arthroplasty.

BACKGROUND

Pneumonia (PNA) is a leading cause of hospitalization among older adults, yet its effect on complications following total joint arthroplasty (TJA) remains unknown. This study evaluated the association between PNA within two years prior to total hip arthroplasty (THA) or total knee arthroplasty (TKA) and periprosthetic joint infection (PJI) and other complications.

METHODS

Patients undergoing primary THA or TKA were identified from a national administrative claims database. Patients who had prior PNA were matched to controls who did not have PNA based on demographics and baseline comorbidities. Outcomes included postoperative medical and surgical complications, including PJI. Subgroup analyses were performed by PNA etiology and timing relative to surgery.

RESULTS

In the THA cohort, 14,607 patients who had prior PNA were matched to 14,607 controls. Overall PNA was not associated with increased PJI risk; however, prior Staphylococcal PNA was (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2 to 5.0), particularly when occurring within three months of surgery (OR 5.2, 95% CI 1.8 to 14.5). In the TKA cohort, 6,271 matched pairs were analyzed. Overall PNA was not associated with increased PJI risk (P = 0.218), while bacterial PNA was (OR 1.98, P = 0.002); viral PNA was not (P = 0.842). Klebsiella pneumoniae carried the highest PJI risk (OR 12.22, P < 0.001). Bacterial PNA occurring three to six months (OR 2.78, P = 0.022) and six to 12 months prior to TKA (OR 2.98, P = 0.001) was also associated with increased PJI odds.

CONCLUSIONS

Pathogen-specific PNA demonstrated time-dependent associations with PJI following TJA. Staphylococcal PNA within three months of THA and bacterial PNA, particularly Klebsiella pneumoniae, occurring three to 12 months before TKA were associated with elevated PJI risk. These findings suggest that PNA etiology and timing may be relevant in preoperative risk assessment for TJA.