Impact of Preoperative Colonoscopy on Revision Surgery Risk in Primary Total Knee Arthroplasty: A Comprehensive Population-Based Analysis

Abstract

Background: In the same age group of patients undergoing total knee arthroplasty (TKA), colonoscopies are performed commonly as part of national colorectal cancer screening pathways. Several authors have reported periprosthetic joint infection (PJI) cases after colonoscopy, suggesting transient bacteremia as a potential mechanism for hematogenous seeding. However, the effect of preoperative colonoscopy on the risk of PJI in prospective TKA patients has been minimally studied. This study aimed to investigate the relationship between preoperative colonoscopy and reoperation and revision rates in TKAs performed for osteoarthritis, using data from Ontario's health care databases.

Methods: This retrospective cohort study identified adults undergoing TKA for osteoarthritis in Ontario, Canada, between 2003 and 2022 through linked databases (CIHI, DAD, and OHIP). Propensity-score matching, Cox proportional hazards regression analysis, Nelson-Aalen curves, and log-log-survival curves were used to evaluate the effect of preoperative colonoscopy on the risk of reoperation and revision arthroplasty due to PJI.

Results: Having a colonoscopy in the 3 months before TKA was associated with a significantly increased risk of TKA-related reoperation and revision TKA (rTKA) (hazard ratio [HR]: 2.20; 95% confidence interval [CI]: 1.05 to 4.63 and HR: 2.59; 95% CI 1.16 to 5.80, respectively). In addition, patients who underwent colonoscopy in the 12 months before TKA had a 1-year rTKA rate of 1.0% compared to 0.5% of patients who did not undergo a colonoscopy in the same time period (P = 0.020). However, having a colonoscopy in the 12 months before TKA was not associated with a significantly increased risk of TKA-related reoperation (HR: 1.43; CI: 0.88 to 2.32) or rTKA (HR: 1.62; CI: 0.94 to 2.78) on multivariate logistic regression analyses.

Conclusions: This study demonstrated a statistically significant association between having a colonoscopy in the 3 months preceding TKA and increased rates of both TKA-related reoperation and rTKA.

Keywords: colonoscopy; periprosthetic Joint infection; reoperation; revision; total knee arthroplasty.