JOA - 2026-03-23 - Journal Article
Outcomes Following Total Hip Arthroplasty in Patients with Cutaneous Psoriasis and Psoriatic Arthritis.
Durbin JW, Cui E, Kesick A, Anderson B, Parel PM, Das A, Gu A, Sterling R, Villa JC
Topics
Key Takeaway
PsA patients undergoing THA carry a 4.7-fold increased odds of 90-day sepsis and 2.9-fold increased odds of deep SSI compared to controls, while PsC patients show a 2.3-fold increased superficial SSI risk and 2.8-fold sepsis risk.
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Summary
This retrospective national database study compared 90-day infectious complications and 2-year revision rates among THA patients with PsC, PsA, and no psoriasis using multivariate logistic regression. PsA conferred greater infectious risk than PsC, with deep SSI OR 2.9 vs. 1.4 and sepsis OR 4.7 vs. 2.8 respectively. Both cohorts had significantly elevated all-cause 2-year revision rates (PsC OR 1.2; PsA OR 1.1).
Key Limitation
The database lacks data on biologic or DMARD use, psoriasis disease activity scores, and skin lesion burden at time of surgery, preventing determination of whether optimized medical management mitigates the observed infectious risk.
Original Abstract
INTRODUCTION
Cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) are associated with higher risks for soft-tissue infection. 48-50 However, there is sparse literature examining psoriasis and infectious complications following total hip arthroplasty (THA). Therefore, the purpose of this study was to observe and compare the rates of (1) superficial surgical site infections (superficial SSI), (2) deep surgical site infections (deep SSI), and (3) 90-day sepsis rates, and two-year revision rates following THA in patients who have PsC and PsA compared to patients who did not have psoriasis.
METHODS
A retrospective database analysis was performed utilizing a large national database. Patients who underwent THA were identified using Current Procedural Terminology (CPT) codes. In total, 593,013 patients were included, of whom 10,230 patients (1.7%) had PsC and 1,445 patients (0.2%) had PsA. Patients were then classified into three cohorts: (1) PsA, (2) PsC, and (3) patients who do not have either condition (control). Multivariate logistic regressions were utilized to compare the outcomes between study cohorts.
RESULTS
Patients who have PsC had higher 90-day superficial SSI (odds ratio (OR): 2.3; CI: 2.2 to 2.5; P < 0.001), deep SSI (OR: 1.4; 1.2 to 1.5; P < 0.001), wound complications (OR: 1.1; 1.1 to 1.3; P < 0.001), sepsis (OR: 2.8; 2.6 to 3.0; P < 0.001), and aseptic revision (OR: 1.2; CI: 1.2 to 1.3; P < 0.001), while patients who have PsA had higher 90-day superficial SSI (OR: 1.7; CI: 1.4 to 2.0; P < 0.001), sepsis (4.7; 4.3 to 5.2; P < 0.001), and deep SSI (2.9; 2.5 to 3.3; P < 0.001). In addition, both cohorts had a higher two-year all-cause revision PsC (1.2; 1.1 to 1.2; P < 0.001) and PsA (1.1; 1.0 to 1.3; P < 0.001).
CONCLUSION
This study showed both manifestations of psoriasis are associated with risks of complications following THA. In particular, both PsC and PsA were associated with higher rates of infections and all-cause revisions. These findings underscore the importance of perisurgical optimizations, including an interdisciplinary team to control flare-ups with enhanced infection prevention measures and patient counseling to reduce complications.