Psoriasis and Post-Surgical Infections in Primary Total Knee Arthroplasty: An Analysis of 10,727 Patients

Background: Psoriasis is a dermatologic condition characterized by erythematous plaques that may in-crease wound complications and deep infections following total knee arthroplasty (TKA). There is a paucity of evidence concerning the association of this disease and complications after TKA. This study aimed to determine if patients who have psoriasis vs non-psoriatic patients have differences in de-mographics and various comorbidities as well as post-operative infections, specifically the following: (1) wound complications; (2) cellulitic episodes; and (3) deep surgical site infections (SSIs). Methods: We identified 10,727 patients undergoing primary TKA utilizing an institutional database be-tween January 1, 2017 and April 1, 2019. A total of 133 patients who had psoriasis (1.2%) were identified using International Classification of Diseases, Tenth Revision codes and compared to non-psoriatic pa-tients. The rate of wound complications, cellulitic episodes, and deep SSIs were determined. After con-trolling for age and various comorbidities, multivariate analyses were performed to identify the associated risks for post-operative infections. Results: Psoriasis patients showed an increased associated risk of deep SSIs (3.8%) compared to non -psoriasis patients (1.2%, P = .023). Multivariate analyses demonstrated a significant associated risk of deep SSIs (odds ratio 7.04, 95% confidence interval 2.38-20.9, P < .001) and wound complications (odds ratio 4.44, 95% confidence interval 1.02-19.2, P = .047). Conclusion: Psoriasis is an inflammatory dermatologic condition that warrants increased pre-operative counseling, shared decision-making, and infectious precautions in the TKA population given the increased risk of wound complications and deep SSIs. Increased vigilance is required given the coexis-tence of certain comorbidities with this population, including depression, substance use disorder, smoking history, gastroesophageal reflux disease, and inflammatory bowel disease. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study found an increased risk of deep surgical site infections (SSIs) in patients with psoriasis after total knee arthroplasty (TKA). Therefore, increased pre-operative counseling, shared decision-making, and infectious precautions are necessary in the TKA population with psoriasis, and attention should be paid to the comorbidities of psoriasis patients.