JOA - 2026-09-04 - Journal Article
Impact of Gastrointestinal Bleeding History on Postoperative Outcomes in Total Hip and Knee Arthroplasty: A Retrospective Analysis.
Botolin P, Helbing J, Khanuja HS, Patel NK, Goldman AH
Topics
Key Takeaway
Prior GI bleeding within 2 years increased 2-year odds of revision surgery by 40% in both THA (OR 1.4) and TKA (OR 1.4), with TKA patients specifically showing 30% higher odds of PJI (OR 1.3) and THA patients showing 60% higher odds of mechanical loosening (OR 1.6).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This matched retrospective cohort study evaluated whether GI bleeding history within 2 years prior to THA or TKA was associated with increased postoperative complications. GI bleed patients were 1:1 matched to controls across 6,420 THA pairs and 9,688 TKA pairs, with outcomes assessed at 90 days and 2 years. GI bleed history was associated with increased revision surgery in both cohorts (OR 1.4), PJI specifically in TKA (OR 1.3, P=0.012), mechanical loosening specifically in THA (OR 1.6, P=0.044), and greater 90-day medical complications including UTI in both groups.
Key Limitation
Database design prevents determination of GI bleed etiology, severity, or whether anticoagulation use mediates the observed associations, making causal inference impossible.
Original Abstract
INTRODUCTION
Gastrointestinal (GI) bleeding is common in older adults and contributes to immune dysregulation, yet its impact on total hip (THA) and total knee (TKA) arthroplasty outcomes is poorly understood. We evaluated the association between GI bleeding history with risk of periprosthetic joint infection (PJI) and other complications up to two years following THA and TKA.
METHODS
A retrospective review identified patients who had a history of GI bleeding within two years prior to THA or TKA. Patients were matched to a control cohort who had no GI bleeding history. The THA cohort included 6,420 GI bleed and 6,420 control patients. The TKA cohort included 9,688 GI bleed and 9,688 control patients. Odds ratios were calculated for 90-day and 2-year outcomes.
RESULTS
In the THA cohort, GI bleed within two years prior to surgery was not associated with PJI (odds ratio (OR): 1.1 [0.8 to 1.4]; P = 0.544) at two years; however, it was associated with increased odds of mechanical loosening (OR: 1.6 [1.01 to 2.5]; P = 0.044) and revision surgery (OR: 1.4 [1.1 to 1.8]; P = 0.002). In the TKA cohort, GI bleed history was associated with greater 2-year odds of PJI (OR: 1.3 [1.1 to 1.7]; P = 0.012) and revision surgery (OR: 1.4 [1.2 to 1.7]; P < 0.001). The GI bleed patients in both cohorts demonstrated greater 90-day medical complication odds, including urinary tract infection (P < 0.05).
CONCLUSION
A GI bleeding history was associated with increased 90-day medical and 2-year surgical complications following THA and TKA. Patients undergoing THA had higher odds of mechanical loosening, whereas TKA patients demonstrated higher odds of PJI. While the complication rate was low, these findings should be interpreted cautiously and viewed as hypothesis-generating. Further prospective studies are needed to better characterize postoperative risk factors in this population.