Inflammatory Bowel Disease Is Associated With Persistent Functional Impairment and Increased Short- and Long-Term Complications Following Total Knee Arthroplasty

Background Inflammatory bowel disease (IBD) is increasingly prevalent, and more affected patients are undergoing total knee arthroplasty (TKA). However, the effect of comorbid IBD on short- and long-term postoperative outcomes after TKA remains incompletely defined, particularly for functional and implant-related complications. Existing TKA-specific literature has not clearly established whether this risk persists across multiple postoperative time points. Methods We performed a retrospective cohort study using the TriNetX Research Network. Adults undergoing primary TKA were identified and stratified by IBD status. Propensity score matching (1:1) balanced demographics and comorbidities, yielding 6134 patients per cohort. Outcomes were assessed at 90 days, 6 months, 2 years, and 5 years and included infectious, thromboembolic, medical, functional, and implant-related complications. Risk ratios with 95% confidence intervals were calculated for each endpoint. Matched cohorts were followed longitudinally across four predefined postoperative intervals after surgery. Results Patients with IBD demonstrated significantly increased risks of sepsis, pulmonary embolism, acute kidney failure, and periprosthetic joint infection/deep surgical site infection as early as 90 days. Several risks persisted through 5 years, including thromboembolic events, ischemic stroke, fall risk, abnormal gait, and implant failure. At 5 years, revision TKA rates did not differ significantly between cohorts despite the greater complication burden observed in patients with IBD. Conclusions Preoperative IBD was associated with sustained postoperative morbidity after TKA, spanning infectious, thromboembolic, functional, and implant-related domains. These findings support enhanced perioperative optimization, closer long-term surveillance, and targeted management strategies for this high-risk population.