JOA - 2026-07-03 - Journal Article
Preoperative Pneumonia and Its Association With Periprosthetic Joint Infection and Postoperative Complications After Total Hip and Knee Arthroplasty.
Parmar RP, Alhankawi AR, Holle AM, Verhey JT, Van Schuyver P, Tarabichi S, Deckey DG, Bingham JS
Topics
Key Takeaway
Klebsiella pneumoniae pneumonia within 2 years of TKA carries a 12.22-fold increased PJI odds ratio, and Staphylococcal pneumonia within 3 months of THA carries a 5.2-fold increased PJI odds ratio.
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Summary
This study asked whether preoperative pneumonia within 2 years of primary THA or TKA is associated with increased PJI and postoperative complication risk, using a national administrative claims database with propensity-matched controls. Overall pneumonia history was not associated with PJI in either cohort, but pathogen-specific analysis revealed Staphylococcal pneumonia within 3 months of THA (OR 5.2) and bacterial pneumonia—especially Klebsiella pneumoniae (OR 12.22)—within 3–12 months of TKA conferred significantly elevated PJI risk. Viral pneumonia was not associated with increased PJI risk in either cohort.
Key Limitation
Claims data cannot verify pneumonia pathogen eradication or confirm microbiologic concordance between the preoperative pulmonary pathogen and the subsequent PJI organism, which is essential to establish a mechanistic link.
Original Abstract
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.
DISCUSSION
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.