# Inflammatory Bowel Disease and Joint Surgery: A 20-Year Cohort Study of Arthroplasty and Arthritis Risks

## TL;DR

People with inflammatory bowel disease are less likely to get hip or knee replacements but more likely to develop certain types of arthritis.

## Contribution

This study provides new insights into the relationship between IBD and joint surgery risks using a large, propensity-matched cohort.

## Key findings

- IBD patients were less likely to undergo THA and TKA compared to the general population.
- IBD patients had a higher risk of developing enteropathic arthropathy and inflammatory polyarthropathies.
- Despite arthritis associations, IBD patients had lower rates of hip and knee osteoarthritis diagnoses.

## Abstract

Background

Patients with inflammatory bowel disease (IBD) have a higher risk of adverse outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) compared to the general population. However, existing literature has not fully elucidated the risk of IBD patients to undergo arthroplasty for treatment of arthritis. Therefore, the purpose of this study is to understand the incidence of arthroplasty and osteoarthritis, enteropathic arthritis, or inflammatory polyarthropathies in patients with IBD compared to the general population.

Methods

A retrospective cohort analysis was conducted using the TriNetX research database to identify all patients who experienced the primary outcomes between 2004 and 2024. Two cohorts were stratified by a diagnosis of IBD and propensity score matched (1:1) to mitigate baseline differences in demographics and comorbidities.

Results

After propensity matching, each cohort contained 531,263 patients who were included for analysis. Patients with IBD were significantly less likely to undergo THA (OR 0.853, 95% CI 0.804-0.906) and TKA (OR 0.830, 95% CI 0.788-0.874) and less likely to incur a diagnosis of hip osteoarthritis (OR 0.943, 95% CI 0.922-0.965) or knee osteoarthritis (OR 0.794, 95% CI 0.780-0.808). Conversely, IBD patients were significantly more likely to incur a diagnosis of enteropathic arthropathy (OR 287.9, 95% CI 181.3-457.5) or inflammatory polyarthropathies (OR 1.390, 95% CI 1.365-1.414).

Conclusions

Patients with IBD are less likely to undergo THA and TKA despite the association between IBD and arthritis. These findings underscore the importance of tailored treatment strategies for joint-related complications in IBD patients and highlight the need for further research to optimize surgical outcomes in this population.