Optimal Timing of Bronchoscopy After Total Joint Arthroplasty: Impact on Periprosthetic Joint Infection and Revision Rates.

BACKGROUND

The possible contribution of bronchoscopy to elevated periprosthetic joint infection (PJI) risks after total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is a critical knowledge gap, despite its widespread use. This study aimed to (1) determine the PJI and revision rates over 30 months following TKA and THA in patients who underwent bronchoscopy within 18 months after surgery and (2) assess the role of the interval between arthroplasty and bronchoscopy in influencing these outcomes.

METHODS

In this retrospective study, a large national database that includes data from more than 165 million cases was used to identify patients who had bronchoscopy within 18 months after TJA and patients who had not. These two groups were matched at a 1:1 ratio according to confounding factors. A total of 2,128 patients underwent bronchoscopy in the THA group, whereas 3,101 patients did so in the TKA group. The PJI and revision rates were assessed over 30 months following the TJA. To investigate the effect of bronchoscopy timing on PJI rates, we divided patients into four groups based on the time between their arthroplasty and bronchoscopy.

RESULTS

Multivariate logistic regression revealed a statistically significant increase in the risk of PJI and revision in patients who underwent bronchoscopy within 18 months after TKA (PJI: odds ratio = 1.55, P < 0.001; revision: odds ratio = 1.35, P = 0.035), but not after THA. Further period subanalysis on the PJI rate indicated that patients undergoing bronchoscopy within zero to three months and six to nine months after TKA had a higher risk of PJI. There were no statistically significant differences observed in other periods.

CONCLUSIONS

Our research provides conclusive evidence that bronchoscopy increases the risk of PJIs, especially within the nine months following TKA. These results highlight how important it is for perioperative patient care to have multidisciplinary collaboration and precise risk management techniques.