COLONOSCOPY WITHIN SIX MONTHS BEFORE TOTAL KNEE ARTHROPLASTY MAY BE ASSOCIATED WITH WORSE POSTOPERATIVE OUTCOMES: A NATIONAL DATABASE ANALYSIS

Introduction Data on the risk of postoperative infection and complications related to transient bacteremia in patients who underwent colonoscopy prior to primary total knee arthroplasty (TKA) remain limited. Therefore, we aimed to evaluate the incidence of periprosthetic joint infection (PJI) and other surgical complications in patients who underwent colonoscopy within six months before primary TKA. Methods A retrospective cohort study using an all-payer national database (PearlDiver) was conducted between 2010-2020 to identify adult patients who underwent primary unilateral TKA. Inclusion criteria required one year of postoperative follow-up. Patients who underwent colonoscopy within 6 months preceding TKA were identified (n=25,291). These patients were matched in a 1:1 ratio to patients without a history of colonoscopy using propensity score matching. Matching variables included age, gender, body mass index (BMI), smoking status, Elixhauser comorbidity index (ECI), hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cancer diagnosis. Outcomes included 90-day, 1- and 2-year PJI, and postoperative healthcare utilization. Results There were no significant differences in PJI at 90 days (OR 0.92, p =0.34), 1 year (OR 0.93, p =0.33), or 2 years (OR 0.98, p =0.74) between groups. Patients with prior colonoscopy had higher odds of 90-day ED visits (OR 1.14, p <0.001), reoperations (OR 1.14, p <0.01), and readmissions (OR 1.12, p <0.01), as well as increased 1-year reoperations (OR 1.07, p =0.03). No significant differences were found in rates of 90-day sepsis, surgical site infection (SSI), hematoma, or wound dehiscence ( p >0.05 for all). Stratified analyses by timing of colonoscopy (0–2, 2–4, 4–6 months preoperatively) showed no significant difference in PJI risk compared to patients without colonoscopy ( p >0.05). Conclusion Colonoscopy within six months before TKA was not associated with an increased risk of PJI. However, its association with higher short-term healthcare utilization warrants further investigation to better understand potential contributing factors.