JOA - 2026-08-17 - Journal Article
Elevated Risk of Periprosthetic Joint Infection and Revision in Patients Who Have Psoriasis after Total Knee Arthroplasty: A Propensity-Matched Cohort Analysis.
Sontam TR, Tummala S, Janett J, Valencia AA, Thota R, Sambandam SN
Topics
Key Takeaway
Psoriasis patients undergoing TKA face a 50% higher relative risk of PJI (RR 1.5, CI 1.1–2.1) and revision TKA (RR 1.5, CI 1.1–2.0) at two years compared to propensity-matched controls.
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Summary
This study asked whether psoriasis independently elevates complication risk after primary TKA using propensity-matched analysis of a large multi-institutional EHR database. Psoriasis patients had significantly higher 90-day rates of DVT (RR 1.5, CI 1.1–2.0) and wound disruption (RR 1.7, CI 1.1–2.6). At two years, PJI risk (RR 1.5, CI 1.1–2.1) and revision TKA risk (RR 1.5, CI 1.1–2.0) were both elevated, while periprosthetic fracture and mechanical loosening rates did not differ significantly.
Key Limitation
The EHR database lacks data on psoriasis severity (PASI score), biologic or DMARD use, and skin lesion proximity to the surgical field—variables that likely drive the observed infection and wound complication risk and are essential for risk stratification.
Original Abstract
BACKGROUND
Total knee arthroplasty (TKA) is a highly successful procedure for managing arthritis, though complications such as periprosthetic joint infection (PJI), periprosthetic fracture (PPFx), and mechanical loosening can occur. Psoriasis has been associated with an increased likelihood of requiring TKA.
METHODS
A large, multi-institutional electronic health records database was utilized to identify patients who had an active diagnosis of psoriasis within three months prior to undergoing TKA. Using propensity-score matching, these patients were matched 1:1 with a cohort of patients who did not have psoriasis prior to TKA. Outcomes assessed at 90-days postoperatively included wound disruption, infection, pulmonary embolism, deep vein thrombosis (DVT) of the lower extremity, acute kidney injury (AKI), and readmissions. The two-year outcomes included PPFx, PJI, mechanical loosening, and revision total knee arthroplasty (rTKA). A total of 156,015 patients undergoing primary TKA were identified. Ultimately, 4,191 patients who had psoriasis were propensity matched to 4,191 controls.
RESULTS
Patients who had psoriasis were at a greater risk of developing DVT (RR [relative risk]: 1.5; CI [confidence interval]: 1.1 to 2.0) and wound disruption (RR: 1.7; CI: 1.1 to 2.6) at 90 days postoperatively. At two years postoperatively, patients who had psoriasis had higher rates of PJI (RR: 1.5; CI: 1.1 to 2.1) and rTKA (RR: 1.5, CI: 1.1 to 2.0).
CONCLUSIONS
Patients who have psoriasis undergoing TKA have a higher risk of wound disruption and DVT of the lower extremity within 90 days, and of PJI and rTKA within two years. The elevated risk of these complications warrants particular attention from orthopaedic surgeons and their patients who have psoriasis in both preoperative shared decision-making and close follow-up care.