Does Inflammatory Bowel Disease Elevate Infection Risk in Total Hip Arthroplasty? Insights from a nationwide study highlighting steroid use as the key determinant

Does Inflammatory Bowel Disease Elevate Infection Risk in Total Hip Arthroplasty? 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Insights from a nationwide study highlighting steroid use as the key determinant Seok Ha Hong, Yeon Ju Yu, Seung Beom Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5669146/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Oct, 2025 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction This study investigated the association between medication status and total hip arthroplasty (THA) complications in patients who have inflammatory bowel disease (IBD), considering varying illness severities. Materials and Methods This retrospective analysis of the National Health Insurance Review and Assessment Service database in South Korea, included patients undergoing unilateral THA between 2012–2022, specifically those diagnosed with IBD. Propensity score matching was used to adjust for baseline characteristics between IBD and non-IBD cohorts, with a matching ratio of 1:10. Results There was a significant difference between the IBD (n = 962) and non-IBD matched groups (n = 9,620) in terms of chronic periprosthetic joint infection (PJI) (2.1 vs 1.3%, P = 0.03) but not with acute PJI or other surgical complications (periprosthetic fracture, dislocation, and aseptic loosening). Medication use itself was not associated with PJI, except for corticosteroid use, significantly associated with PJI among IBD medications (OR: 2.79 [1.03–10.68], P = 0.04). Multivariable analysis indicated a significant increase in PJI risk with corticosteroid use within one year before THA (OR: 3.30 [1.21–10.86], P = 0.01). Patients not using steroids did not exhibit an inherent risk of IBD related complications. Conclusions This nationwide study confirmed that IBD increases the risk of chronic PJI. Preoperative corticosteroid use within the year before arthroplasty significantly increased the risk of PJI, particularly in patients with poorly controlled IBD and acute flares-up. Conversely, well-controlled IBD did not correlate with increased surgical complications. Attention should be directed towards recognizing the risk of steroid use, such as acute flares in cases of uncontrolled IBD, to optimize preoperative treatment for IBD undergoing arthroplasty. Level of Evidence Level III, Prognostic Inflammatory bowel disease Total hip arthroplasty Periprosthetic joint infection Nationwide study Preoperative steroid use Figures Figure 1 Figure 2 INTRODUCTION Recent studies have indicated that inflammatory bowel disease (IBD) not only affects the gastrointestinal tract but also exerts various effects on the musculoskeletal system [ 1 – 3 ]. Patients diagnosed with IBD often demonstrate a higher prevalence of osteoporosis attributed to factors such as diminished bone mineral density, and heightened rates of collagen breakdown [ 4 – 6 ]. Moreover, IBD related nutritional deficiencies have been observed to adversely affect bone health and joint function in affected individuals [ 7 – 9 ]. Emerging evidence indicates that IBD pateints undergoing total hip arthroplasty (THA) may face elevated risks of postoperative complications [ 10 – 15 ]. A study by Moran et al emphasized that individuals with IBD are at an increased likelihood of necessitating revision surgery for septic causes following THA compared to their non-IBD counterparts [ 13 ]. Additionally, Kapadia et al reported lower implant survivorship rates and heightened occurrences of major complications among patients who have IBD undergoing THA, when compared with matched controls [ 16 ]. A recent study by Chisari et al further elucidated the heightened rates of prosthetic joint infections and aseptic loosening observed in patients who have IBD undergoing THA, compared to non-IBD controls [ 17 ]. However, amidst these findings, it is crucial to recognize the diverse spectrum of presentations of patients who have IBD, and that some individuals may exhibit well-controlled conditions without the need for specific medication. Despite this diversity, only few single center studies have explored the relationship between medication use, varying disease severity, and the occurrence of complications after arthroplasty in this population. Therefore, this study aimed to address this gap by examining the association between medication status and the incidence of arthroplasty complications in IBD patients, with a particular focus on the impact of different levels of medication intensity. Using nationwide claims data, we aim to clarify the role of IBD medications in influencing postoperative outcomes following THA. MATERIALS AND METHODS Data source This retrospective study was approved by our institutional review board (2023AN0470). Data for this nationwide population-based study were obtained from the National Health Insurance Review and Assessment Service (HIRA) database, utilizing diagnoses coded according to the International Classification of Diseases (ICD-10) and procedure history based on Electronic Data Interchange codes. Notably, South Korea’s public medical insurance system provides coverage for nearly the entire population, ensuring comprehensive representation in the HIRA database, with no private insurance system in place [ 18 ]. The data within the HIRA database are generated during reimbursement of insurance covered claims under the National Health Insurance Service [ 19 ]. In recent years, the HIRA database of South Korea, renowned for its completeness and validity, has served as a primary data source for numerous epidemiological studies [ 20 , 21 ]. This database contains deidentified information encompassing the entire insured population between 2011–2022, including age, sex, diagnoses, prescription records, hospital admissions, visit dates, and patients’ procedure history. Study cohort This study population comprised individuals who had undergone a unilateral THA (Electronic Data Interchange: N0711 or N2070), as documented by the primary procedure in the HIRA database between January 1, 2012, and December 31, 2022. Due to the inherent lack of directional information in HIRA data, making it difficult to determine postoperative complications in cases of bilateral surgeries, patients who underwent bilateral procedures were excluded from the analysis. To exclude patients who underwent bilateral THAs, those with a history of previous THAs were identified and excluded in the washout period of the preceding year from the index date of THA. To ensure that patients were not counted twice in the database, the “FIRST_INSTANCE” command was utilized to ensure that only patients undergoing primary THA for the first time were included in the study. The IBD cohort was subsequently filtered to include all patients who have diagnostic codes for Crohn’s disease (CD) (K50) and ulcerative colitis (UC) (K51). However, Crohn's disease (CD) and ulcerative colitis (UC), recognized as rare diseases by the HIRA in South Korea, are eligible for special treatment benefits under the national health insurance system, which ensures higher diagnostic specificity [ 22 ]. This is because these conditions require specific diagnostic codes for treatment registration, thereby offering substantial insights into patient profiles and disease characteristics for analysis using HIRA data. Utilizing the designation as a rare disease, patients diagnosed with IBD were stratified into groups based on the need for medication, distinguishing between those well-controlled without medication and those requiring medication. Furthermore, within the medication requiring group, patients were stratified according to the medication step, delineated by 5-aminosalicylates (5-ASA), steroids, and tumor necrosis factor-alpha inhibitor (anti-TNF) therapies, while analyzing whether medication was administered within one year before the time of surgery or postoperatively. This enabled a comprehensive analysis across different medication intensities (Table 1 ). Table 1 Baseline medication exposure and disease characteristics of IBD a patients IBD cases N = 962 IBD subtype, n (%) Ulcerative colitis 813 (84.6) Crohn’s disease 148 (15.5) Medication status, n (%) Never administered 687 (71.5) Administered at least once 272 (28.5) Medication subtype within 1 year before surgery, n (%) ASA b 136 (14.2) Corticosteroid 51 (5.3) Any anti-TNFa 11 (1.1) Postoperative initiation of medication for IBD, n (%) ASA 61 (6.3) Corticosteroid 12 (1.2) Any anti-TNF c 3 (0.3) a IBD, inflammatory bowel disease; b ASA, aminosalicylates; c Anti-TNF, tumor necrosis factor alpha inhibitor Matching the study and control cohorts Propensity score matching (PSM) was used to adjust for baseline characteristics between the IBD and non-IBD cohorts. Matched variables included sex, age distribution, year of surgery, hip joint diagnoses for which THA was performed, and the Charlson Comorbidity Index (CCI). A matched index date was assigned to each participant in the non-IBD group. A 1:10 matching of the IBD and control cohorts was performed with the use of a nearest neighbor matching algorithm, with a maximum caliper of 0.03 for the hazard components. Outcome An operational definition of surgical and periprosthetic complications was established. For superficial surgical site infections, the ICD-10 diagnostic code indicating surgical site infection and dehiscence (T814) was utilized. For the diagnosis of periprosthetic joint infection (PJI), ICD-10 diagnosis codes indicating PJI: T845, T846, T847, and T857 (Supplementary Table S1 , Appendix) were used. Acute PJI was defined as occurring within four weeks after index surgery, while chronic PJI was defined as more than four weeks after index surgery. For the diagnosis of periprosthetic fractures, the ICD-10 diagnostic code indicating prosthesis fractures (M966) was used. In the case of the diagnosis of dislocations, the ICD-10 diagnosis codes indicating prosthesis complications or dislocations (T84 and S730) were utilized. Early dislocation was defined as occurring within 12 weeks after index surgery, while late dislocation was defined as emerging more than 12 weeks after index surgery. With regard to the diagnosis of loosening and other prosthesis complications for revision, ICD-10 diagnosis codes indicating T84 and T85, and excluding infection were used, along with surgical procedure codes for the revision of one or both components (N1711, N1721, N3710 and N3720). Data analyses A logistic regression model was constructed to estimate the likelihood of IBD in THA, with adjustments made for all covariates. These included age distribution, sex, diagnosis, year of surgery, and comorbidities. The balance of measured confounders pre-PSM and post-PSM was assessed using absolute standardized differences. Continuous data were analyzed using the student t- test, and categorical data were analyzed using the C hi- square test. Kaplan-Meier survival analyses were performed to determine the cumulative incidence rates for periprosthetic complications, with log-rank tests used to analyze differences in the cumulative incidence rate curves. Adjusted HRs and 95% confidence intervals (CI) were calculated to investigate the risk of PJI according to the duration from the index date of THA, using multivariable Cox proportional hazards regression modeling, while controlling for age, sex, year of surgery, and comorbidities. Multivariable Cox proportional hazards regression analyses were conducted to identify risk factors for PJI from THA. Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc, Cary, NC) and R statistical software version 3.3.3 (Foundation for Statistical Computing, Vienna, Austria). Statistical significance was defined as P < .05. RESULTS Baseline demographics A total of 962 patients who have IBD were identified and matched with 9620 control patients who underwent a unilateral THA (Fig. 1 ). Before the PSM, there were significant differences in sex, age, CCI, and underlying diseases (heart failure, stroke, peripheral vascular disorder, rheumatoid arthritis, chronic obstructive pulmonary disease, mild liver disease, diabetes mellitus (DM), DM with complications, solid tumor, and peptic disease) ( P < 0.001) (Table 2 ). After the PSM, there was a balance between both groups in terms of baseline covariates, with a standardized mean difference of < 0.01. Table 2 Baseline Characteristics of the Cohorts Before and After Propensity Score Matching Characteristic Unmatched Cohort(N = 91,158) Matched Cohort (N = 10,582) IBD a (N = 962) Non-IBD (N = 90,196) P -value IBD (N = 962) Non-IBD (N = 9,620) SMD b Sex, n (%) 0.01 0.001 Men 510 (53.0) 44,246 (49.1) 504 (52.8) 5,085 (52.9) Women 452 (47.0) 45,950 (50.9) 451 (47.2) 4,535 (47.1) Age distribution (y), n (%) 0.003 0.005 10–20 1 (0.1) 56 (0.1) 1 (0.1) 7 (0.1) 20–30 21 (2.2) 1,565 (1.7) 21 (2.2) 222 (2.3) 30–40 41 (4.3) 5,280 (5.9) 41 (4.3) 429 (4.5) 40–50 106 (11.0) 11,345 (12.6) 106 (11.0) 1,066 (10.8) 50–60 214 (22.2) 21,752 (24.1) 214 (22.2) 2,127 (22.2) 60–70 289 (30.1) 23,685 (26.3) 289 (30.1) 2,931 (30.6) 70–80 235 (24.4) 19,819 (22.0) 235 (24.4) 2,281 (23.8) 80–90 54 (5.6) 6,393 (7.1) 54 (5.6) 557 (5.8) 90–100 0 (0.0) 301 (0.3) 0 (0.0) 0 (0.0) Diagnosis, n (%) 0.1 0.001 Osteonecrosis of femoral head 521 (54.2) 45,302 (50.2) 521 (54.2) 5,215 (54.3) Osteoarthritis 261 (27.1) 27,142 (30.1) 261 (27.1) 2,579 (26.8) Femoral neck fracture 180 (18.7) 17,752 (19.7) 180 (18.7) 1,826 (18.9) Year of surgery, n(%) 0.48 2012 82 (8.6) 6,686 (7.4) 82 (8.6) 788 (8.2) 2013 59 (6.2) 6,838 (7.6) 59 (6.2) 585 (6.1) 2014 85 (8.8) 7,043 (7.8) 85 (8.8) 808 (8.4) 2015 82 (8.5) 7,164 (7.9) 82 (8.5) 826 (8.6) 2016 67 (7.0) 7,595 (8.4) 67 (7.0) 692 (7.2) 2017 92 (9.6) 8,057 (8.9) 92 (9.6) 906 (9.4) 2018 92 (9.6) 8,478 (9.4) 92 (9.6) 918 (9.6) 2019 97 (10.1) 9,016 (10.0) 97 (10.1) 969 (10.1) 2020 94 (9.8) 8,717 (9.7) 94 (9.8) 985 (10.3) 2021 104 (10.8) 9,926 (11.0) 104 (10.8) 1,060 (11.0) 2022 107 (11.1) 10,676 (11.8) 107 (11.1) 1,061 (11.1) Charlson Comobidty Index , mean ± SD c 6.0 ± 3.2 5.0 ± 3.1 0.00 6.0 ± 3.1 6.0 ± 3.2 -0.002 Comorbidities, n (%) Myocardial Infarction 40 (4.2) 3,079 (3.4) 0.24 40 (4.2) 368 (3.8) 0.002 Congestive Heart Failure 183 (19.0) 13,358 (14.8) 0.00 183 (19.0) 1,793 (18.7) 0.003 Peripheral vascular disorders 431 (44.8) 35,770 (39.7) 0.00 431 (44.8) 4,280 (44.6) 0.001 DM d 514 (53.4) 41,625 (46.1) 0.00 514 (53.4) 5,083 (53.0) 0.004 Rheumatoid arthritis 332 (34.5) 24,689 (27.4) 0.00 332 (34.5) 3,348 (34.9) 0.000 Cerebrovascular disease 319 (33.2) 22,758 (25.2) 0.00 319 (33.2) 3,149 (32.8) 0.005 Dementia 68 (7.1) 5,115 (5.7) 0.07 68 (7.1) 636 (6.6) 0.000 Pulmonary disease 721 (74.9) 60,642 (67.2) 0.00 721 (74.9) 7,202 (75.1) 0.000 Mild liver disease 714 (74.2) 59,866 (66.4) 0.00 714 (74.2) 7,078 (73.8) 0.002 Chronic Kidney Disease 99 (10.3) 6,098 (6.8) 0.00 99 (10.3) 1,023 (10.7) -0.005 DM with complication 177 (18.4) 14,107 (15.6) 0.02 177 (18.4) 1,717 (17.9) 0.004 Moderate to severe liver disease 15 (1.6) 1,623 (1.8) 0.67 15 (1.6) 151 (1.6) -0.001 Peptic disease 754 (78.4) 59,310 (65.8) 0.00 754 (78.4) 7,483 (78.1) 0.002 Solid tumor without metastasis 160 (16.6) 9,586 (10.6) 0.00 160 (16.6) 1,323 (13.9) -0.003 a IBD, inflammatory bowel disease; b SMD, standardized mean difference; c SD, standard deviation; d DM, diabetes mellitus; disease Patients who have IBD compared to controls Patients who have IBD demonstrated a higher incidence of PJI compared to the controls (2.1 (n = 20) vs 1.3% (n = 121); P = 0.03) (Table 3 ). There were no significant differences in other surgical complications (superficial surgical site infection (5.0 (n = 48) vs 4.3% (n = 417); P = 0.34), periprosthetic fractures (1.1 (n = 11) vs 0.9% (n = 82); P = 0.46), both early and late dislocations (2.1 (n = 20) vs 1.6% (n = 176); P = 0.66), and revisions for aseptic loosening (0.3 (n = 3) vs 0.7% (n = 65); P = 0.25) (Fig. 2 ). Furthermore, this difference was observed only in chronic PJI, not in acute PJI between the IBD and non-IBD groups (1.8 (n = 17) vs 1.0% (n = 90); P = 0.02). In addition to IBD (hazard ratio (HR): 1.87, confidence interval (CI) [1.31–2.67], P = 0.001), patients with DM with complications and those with chronic kidney disease were found to have a higher risk of PJI, with HRs of 1.47 (CI [1.01–2.14], P = 0.04) and 1.72 (CI [1.13–2.64], P = 0.01), respectively (Table 4 ). Table 3 Clinical Outcomes of IBD vs. Matched Non-IBD Characteristic IBD (N = 962) Non-IBD (N = 9,620) P -value * Superficial surgical site infection 48 (5.0) 417 (4.3) 0.34 Periprosthetic Joint Infection 20 (2.1) 121 (1.3) 0.03 Acute 3 (0.3) 31 (0.3) 0.99 Chronic 17 (1.8) 90 (1.0) 0.02 Dislocation 20 (2.1) 175 (1.6) 0.66 Early 16 (1.7) 109 (1.1) 0.20 Late 4 (0.4) 66 (0.7) 0.44 Periprosthetic Fracture 11 (1.1) 82 (0.9) 0.46 Revision for aseptic loosening 3 (0.3) 65 (0.7) 0.25 Follow up period, year (median [IQR]) 2.8 [0.8;5.7] 2.9 [0.8;5.8] 0.76 * Wilcoxon rank sum test; Fisher's exact test; Pearson's C hi- square test Table 4 Cox proportional hazards model for risk of Periprosthetic Joint Infection after total hip arthroplasty in matched cohort Variable HR a CI b P -value Adjusted HR CI P -value IBD c 2.39 1.28–5.13 0.01 1.87 1.31–2.67 0.001 Sex 0.91 0.66–1.26 0.56 Diagnosis AVN d Ref OA e 1.25 0.87–1.79 0.23 Femoral neck fracture 1.19 0.77–1.84 0.44 Myocardial Infarction 0.62 0.25–3.13 0.68 Congestive Heart Failure 1.83 0.94–3.55 0.08 Peripheral vascular disorders 0.65 0.35–1.21 0.17 DM f 1.09 0.56–2.13 0.80 DM with complications 1.55 1.02–3.49 0.04 1.47 1.01–2.14 0.04 Rheumatoid arthritis 0.9 0.48–1.66 0.72 Cerebrovascular disease 0.98 0.52–1.85 0.95 Dementia 2.12 0.70–6.43 0.18 Pulmonary disease 1.64 0.74–3.65 0.22 Liver disease 0.93 0.55–1.87 0.83 Chronic Kidney Disease 1.66 1.08–2.55 0.10 1.72 1.13–2.64 0.01 Solid tumor without metastasis 1.08 0.72–1.61 0.69 a HR, hazard ratio; b CI, confidence interval; c IBD, inflammatory bowel disease; d AVN, avascular necrosis; e OA, osteoarthritis; f DM, diabetes mellitus Analyses restricted to patients who have IBD Univariate analysis showed that medication use itself did not increase the risk of chronic PJI, but steroid use was a significant predictor of chronic PJI in both patients who used steroids regardless of the time of surgery (odds ratio (OR): 2.79 [1.03–10.68], P = 0.04) and those who used steroids within 1 year prior to surgery (OR: 3.58 [1.33–11.80], P = 0.03) (Table 5). Multivariable analysis confirmed that steroid usage within 1 year prior to surgery (OR 3.30 [1.21–10.86], P = 0.02) remained a unique and significant independent predictor for chronic PJI. DISCUSSION This study demonstrates that IBD is associated with a significantly higher risk of PJIs in patients who underwent THA, but not in those with aseptic loosening or periprosthetic fractures. Notably, the use of corticosteroids within the year preceding surgery, but not 5-ASA or anti-TNF agents, was associated with an increased risk of PJIs. Studies have investigated the association between IBD and arthroplasty complications. In a single center study, Chisari et al suggested that patients who have IBD experienced higher rates of PJI and aseptic loosening compared to controls [ 17 ]. Additionally, Magruder et al suggested that patients who have IBD who underwent primary THA had a higher risk of implant related complications in a private insurance claims database [ 23 ]. Although previous studies have described an increase in various implant related complications including septic loosening and PJI due to IBD [ 15 , 23 ], our study found an increase in PJI only and no significant difference in other implant complications, including aseptic loosening. This correlates with another real-world data study in which Moran et al suggested that patients who have a history of IBD had a relatively high risk of revision surgery for septic causes but not for aseptic causes in the Swedish Hip Arthroplasty Registry [ 13 ]. Additionally, medication use was stratified among patients who have IBD to confirm its association with PJI. Previous studies have generally included patients who have IBD as a single group without distinguishing between medication usage, and few single center studies have specifically analyzed the effect of medication use on PJI [ 24 ]. Furthermore, some studies have excluded groups of patients taking steroids from their analysis [ 11 , 23 ]. As a result, there are limitations in generalizing findings to all patients who have IBD, an issue highlighted by our study. While the use of medication in general was not associated with PJI in patients who have IBD, the use of steroids was specifically associated with an increased risk of PJI. In patients who have IBD, steroids are typically used during acute flares, whereas 5-ASA or anti-TNF are used for maintenance [ 25 ]. Patients whose condition is well-controlled may not require medication. Our findings are consistent with those of Gregory et al in which anti-TNF therapy for IBD did not cause serious infections after arthroplasty [ 26 ]. In other words, even if a patient has IBD, there may be no complications if the condition is well-controlled. Conversely, THA may significantly increase the risk of PJI in patients who have uncontrolled IBD. Limitation of this study was its reliance on registry data, which may have limited the availability of information on potential confounding factors. The data did not include details of IBD activity, symptoms, or laboratory data. However, including clinical data from sufficient centers to provide adequate authority in providing answers to our questions was not feasible. Miscoding can be a problem with administrative data; however, UC and Crohn’s disease are registered as rare diseases under special provisions. Therefore, while the possibility of misdiagnosing IBD is rare, underreporting may still occur in surgical outcomes. Another limitation was that the study did not account for the potential effect of dosage or the preoperative discontinuation status of medication, and the number of patients using anti-TNF was too small to yield statistically significant results. Also, the temporal categorization of PJI into acute and chronic was based on timeframes, which prevented the analysis of acute hematogenous infections. Furthermore, the lack of directionality specifications in the HIRA data resulted in the exclusion of bilateral surgeries from subsequent complication assessments, which could have led to a selection bias. In conclusion, this nationwide study confirmed that IBD increases the risk of chronic PJI. A sub-analysis based on medication revealed that preoperative steroid use significantly increased this risk. Conversely, well-controlled IBD did not correlate with increased surgical complications, including PJI. Therefore, it is crucial to avoid preconceptions that solely attribute PJI risk to IBD. Instead, awareness should be raised regarding the potential issues associated with steroid use in cases of uncontrolled IBD, such as acute flares. Clinical suggestions include recommending that surgeons consider the patient's IBD clinical activity at the time of surgery or when making surgical indications. Declarations Ethics approval The institutional review board of our hospital approved the design and protocol of this study (2023AN0470). The requirement for informed consent was waived due to the retrospective design of the study Funding This study was supported by the Korea Medical Device Development Fund grant funded by the Korea government (Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (IRIS No. RS-2020-KD000038), which was allocated for data extraction expenses. Author Contribution Hong served as the first author, contributing to the overall drafting of the manuscript, performing data analysis, and overseeing the preparation of tables and figures. 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Clin Orthop Surg 16:217 Lim SS, Lee W, Kim YK, Kim J, Park JH, Park BR, Yoon JH (2019) The cumulative incidence and trends of rare diseases in South Korea: a nationwide study of the administrative data from the National Health Insurance Service database from 2011–2015. Orphanet J Rare Dis 14:1–16 Magruder ML, Parsa S, Gordon AM, Ng M, Wong CHJ (2023) Inflammatory bowel disease patients undergoing total hip arthroplasty have higher odds of implant-related complications. HIP Int :11207000231214768 Hadid B, Buehring W, Mannino A, Weisberg MD, Golub IJ, Ng MK, Razi AE (2023) Crohn's Disease Increases In-Hospital Lengths of Stay, Medical Complications, and Costs of Care following Primary Total Knee Arthroplasty. J Knee Surg 36:524–529 Waljee AK, Wiitala WL, Govani S, Stidham R, Saini S, Hou J, Feagins LA, Khan N, Good CB, Vijan S (2016) Corticosteroid use and complications in a US inflammatory bowel disease cohort. PLoS ONE 11:e0158017 Gregory MH, McKinnon A, Stwalley D, Hippensteel KJ, Loftus EV Jr, Ciorba MA, Olsen MA, Deepak P (2019) Anti-tumour necrosis factor therapy for inflammatory bowel diseases do not impact serious infections after arthroplasty. J Crohn's Colitis 13:182–188 Additional Declarations No competing interests reported. Supplementary Files supplementaltable1.docx Cite Share Download PDF Status: Published Journal Publication published 14 Oct, 2025 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted Editorial decision: Revision requested 15 Jan, 2025 Reviews received at journal 02 Jan, 2025 Reviewers agreed at journal 22 Dec, 2024 Reviewers invited by journal 19 Dec, 2024 Editor assigned by journal 18 Dec, 2024 Submission checks completed at journal 18 Dec, 2024 First submitted to journal 18 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5669146","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":392325031,"identity":"71d8187a-8a0c-41a2-87b7-c4db1661999a","order_by":0,"name":"Seok Ha Hong","email":"","orcid":"","institution":"Korea University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Seok","middleName":"Ha","lastName":"Hong","suffix":""},{"id":392325033,"identity":"ba3e0c46-93b9-4d2d-a98e-5cc57297bf26","order_by":1,"name":"Yeon Ju Yu","email":"","orcid":"","institution":"Korea University","correspondingAuthor":false,"prefix":"","firstName":"Yeon","middleName":"Ju","lastName":"Yu","suffix":""},{"id":392325035,"identity":"ad3eea31-cf93-483d-9e1e-6dfe61e93d33","order_by":2,"name":"Seung Beom Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYFACHiCuSIBzDYjUcoZkLYxtpGjh5z978HPhvDQ58/bmBww/ahiMzRsIaJGckZcsPXNbjrHMmWMGjD3HGMxkDhDQYnCDx0Cad1tF4gyJBAMG3gYGGwlCDjM4f8b4N+8coBb55x8Y/xKl5UCOmTRvQw7QFh4DZqAtZgS1SM7IMbPmOZZmLMGTU3BY5piEMUEt/PxnjG/z1CTLSbAf3/jwTY2N4QxCWlDAAQYGgnaMglEwCkbBKCAGAABULDWmnuayeQAAAABJRU5ErkJggg==","orcid":"","institution":"Korea University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Seung","middleName":"Beom","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2024-12-18 11:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5669146/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5669146/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00402-025-06094-2","type":"published","date":"2025-10-14T15:58:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":72361670,"identity":"f3d9e3b6-c69c-42ba-8637-e347b1a68ce2","added_by":"auto","created_at":"2024-12-26 06:07:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":262615,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study inclusion and exclusion criteria\u003c/p\u003e\n\u003cp\u003eIBD, inflammatory bowel disease; THA, total hip arthroplasty.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5669146/v1/50b2e951dbca655adedacea5.png"},{"id":72361672,"identity":"8c76dafe-7f7d-465c-bad3-f99089516f9c","added_by":"auto","created_at":"2024-12-26 06:07:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":293999,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier curves depicting survivorship after primary total hip arthroplasty (THA) in patients with and without inflammatory bowel disease (IBD) at the time of index surgery. The solid aqua line represents patients who have IBD, whereas the solid red line represents those without IBD diagnosis. Shaded areas denote the 95% confidence interval. Four separate panels depict Kaplan–Meier curves for different outcomes: (a) periprosthetic joint infection, (b) periprosthetic fracture, (c) dislocation, and (d) aseptic loosening.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5669146/v1/f90be67eb51bee1486f688d9.png"},{"id":93957205,"identity":"0dc245cd-17b2-4cc7-87c0-7a5d39aed3c9","added_by":"auto","created_at":"2025-10-20 16:13:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1858636,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5669146/v1/f2ada386-182f-4ed7-b94d-a08e803b201a.pdf"},{"id":72363377,"identity":"0513a71c-e70c-4d51-9bdf-f9733492d965","added_by":"auto","created_at":"2024-12-26 06:15:35","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":16043,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaltable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5669146/v1/ad65bafd14692a76c3a359cb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does Inflammatory Bowel Disease Elevate Infection Risk in Total Hip Arthroplasty? Insights from a nationwide study highlighting steroid use as the key determinant","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eRecent studies have indicated that inflammatory bowel disease (IBD) not only affects the gastrointestinal tract but also exerts various effects on the musculoskeletal system [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patients diagnosed with IBD often demonstrate a higher prevalence of osteoporosis attributed to factors such as diminished bone mineral density, and heightened rates of collagen breakdown [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, IBD related nutritional deficiencies have been observed to adversely affect bone health and joint function in affected individuals [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmerging evidence indicates that IBD pateints undergoing total hip arthroplasty (THA) may face elevated risks of postoperative complications [\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A study by Moran et al emphasized that individuals with IBD are at an increased likelihood of necessitating revision surgery for septic causes following THA compared to their non-IBD counterparts [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, Kapadia et al reported lower implant survivorship rates and heightened occurrences of major complications among patients who have IBD undergoing THA, when compared with matched controls [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A recent study by Chisari et al further elucidated the heightened rates of prosthetic joint infections and aseptic loosening observed in patients who have IBD undergoing THA, compared to non-IBD controls [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, amidst these findings, it is crucial to recognize the diverse spectrum of presentations of patients who have IBD, and that some individuals may exhibit well-controlled conditions without the need for specific medication. Despite this diversity, only few single center studies have explored the relationship between medication use, varying disease severity, and the occurrence of complications after arthroplasty in this population.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to address this gap by examining the association between medication status and the incidence of arthroplasty complications in IBD patients, with a particular focus on the impact of different levels of medication intensity. Using nationwide claims data, we aim to clarify the role of IBD medications in influencing postoperative outcomes following THA.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003e This retrospective study was approved by our institutional review board (2023AN0470). Data for this nationwide population-based study were obtained from the National Health Insurance Review and Assessment Service (HIRA) database, utilizing diagnoses coded according to the International Classification of Diseases (ICD-10) and procedure history based on Electronic Data Interchange codes. Notably, South Korea\u0026rsquo;s public medical insurance system provides coverage for nearly the entire population, ensuring comprehensive representation in the HIRA database, with no private insurance system in place [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The data within the HIRA database are generated during reimbursement of insurance covered claims under the National Health Insurance Service [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In recent years, the HIRA database of South Korea, renowned for its completeness and validity, has served as a primary data source for numerous epidemiological studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This database contains deidentified information encompassing the entire insured population between 2011\u0026ndash;2022, including age, sex, diagnoses, prescription records, hospital admissions, visit dates, and patients\u0026rsquo; procedure history.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy cohort\u003c/h3\u003e\n\u003cp\u003eThis study population comprised individuals who had undergone a unilateral THA (Electronic Data Interchange: N0711 or N2070), as documented by the primary procedure in the HIRA database between January 1, 2012, and December 31, 2022. Due to the inherent lack of directional information in HIRA data, making it difficult to determine postoperative complications in cases of bilateral surgeries, patients who underwent bilateral procedures were excluded from the analysis. To exclude patients who underwent bilateral THAs, those with a history of previous THAs were identified and excluded in the washout period of the preceding year from the index date of THA. To ensure that patients were not counted twice in the database, the \u0026ldquo;FIRST_INSTANCE\u0026rdquo; command was utilized to ensure that only patients undergoing primary THA for the first time were included in the study. The IBD cohort was subsequently filtered to include all patients who have diagnostic codes for Crohn\u0026rsquo;s disease (CD) (K50) and ulcerative colitis (UC) (K51). However, Crohn's disease (CD) and ulcerative colitis (UC), recognized as rare diseases by the HIRA in South Korea, are eligible for special treatment benefits under the national health insurance system, which ensures higher diagnostic specificity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This is because these conditions require specific diagnostic codes for treatment registration, thereby offering substantial insights into patient profiles and disease characteristics for analysis using HIRA data. Utilizing the designation as a rare disease, patients diagnosed with IBD were stratified into groups based on the need for medication, distinguishing between those well-controlled without medication and those requiring medication. Furthermore, within the medication requiring group, patients were stratified according to the medication step, delineated by 5-aminosalicylates (5-ASA), steroids, and tumor necrosis factor-alpha inhibitor (anti-TNF) therapies, while analyzing whether medication was administered within one year before the time of surgery or postoperatively. This enabled a comprehensive analysis across different medication intensities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eBaseline medication exposure and disease characteristics of IBD\u003c/b\u003e\u003csup\u003ea\u003c/sup\u003e \u003cb\u003epatients\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIBD cases\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;962\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBD subtype, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUlcerative colitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e813 (84.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrohn\u0026rsquo;s disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148 (15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication status, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever administered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e687 (71.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministered at least once\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e272 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication subtype within 1 year before surgery, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136 (14.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticosteroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny anti-TNFa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative initiation of medication for IBD, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticosteroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny anti-TNF\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003ea\u003c/sup\u003eIBD, inflammatory bowel disease; \u003csup\u003eb\u003c/sup\u003eASA, aminosalicylates; \u003csup\u003ec\u003c/sup\u003eAnti-TNF, tumor necrosis factor alpha inhibitor\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMatching the study and control cohorts\u003c/h3\u003e\n\u003cp\u003ePropensity score matching (PSM) was used to adjust for baseline characteristics between the IBD and non-IBD cohorts. Matched variables included sex, age distribution, year of surgery, hip joint diagnoses for which THA was performed, and the Charlson Comorbidity Index (CCI). A matched index date was assigned to each participant in the non-IBD group. A 1:10 matching of the IBD and control cohorts was performed with the use of a nearest neighbor matching algorithm, with a maximum caliper of 0.03 for the hazard components.\u003c/p\u003e\n\u003ch3\u003eOutcome\u003c/h3\u003e\n\u003cp\u003eAn operational definition of surgical and periprosthetic complications was established. For superficial surgical site infections, the ICD-10 diagnostic code indicating surgical site infection and dehiscence (T814) was utilized. For the diagnosis of periprosthetic joint infection (PJI), ICD-10 diagnosis codes indicating PJI: T845, T846, T847, and T857 (Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e, Appendix) were used. Acute PJI was defined as occurring within four weeks after index surgery, while chronic PJI was defined as more than four weeks after index surgery. For the diagnosis of periprosthetic fractures, the ICD-10 diagnostic code indicating prosthesis fractures (M966) was used. In the case of the diagnosis of dislocations, the ICD-10 diagnosis codes indicating prosthesis complications or dislocations (T84 and S730) were utilized. Early dislocation was defined as occurring within 12 weeks after index surgery, while late dislocation was defined as emerging more than 12 weeks after index surgery. With regard to the diagnosis of loosening and other prosthesis complications for revision, ICD-10 diagnosis codes indicating T84 and T85, and excluding infection were used, along with surgical procedure codes for the revision of one or both components (N1711, N1721, N3710 and N3720).\u003c/p\u003e\n\u003ch3\u003eData analyses\u003c/h3\u003e\n\u003cp\u003eA logistic regression model was constructed to estimate the likelihood of IBD in THA, with adjustments made for all covariates. These included age distribution, sex, diagnosis, year of surgery, and comorbidities. The balance of measured confounders pre-PSM and post-PSM was assessed using absolute standardized differences. Continuous data were analyzed using the student \u003cem\u003et-\u003c/em\u003etest, and categorical data were analyzed using the C\u003cem\u003ehi-\u003c/em\u003esquare test. Kaplan-Meier survival analyses were performed to determine the cumulative incidence rates for periprosthetic complications, with log-rank tests used to analyze differences in the cumulative incidence rate curves. Adjusted HRs and 95% confidence intervals (CI) were calculated to investigate the risk of PJI according to the duration from the index date of THA, using multivariable Cox proportional hazards regression modeling, while controlling for age, sex, year of surgery, and comorbidities. Multivariable Cox proportional hazards regression analyses were conducted to identify risk factors for PJI from THA. Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc, Cary, NC) and R statistical software version 3.3.3 (Foundation for Statistical Computing, Vienna, Austria). Statistical significance was defined as \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline demographics\u003c/h2\u003e \u003cp\u003eA total of 962 patients who have IBD were identified and matched with 9620 control patients who underwent a unilateral THA (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Before the PSM, there were significant differences in sex, age, CCI, and underlying diseases (heart failure, stroke, peripheral vascular disorder, rheumatoid arthritis, chronic obstructive pulmonary disease, mild liver disease, diabetes mellitus (DM), DM with complications, solid tumor, and peptic disease) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After the PSM, there was a balance between both groups in terms of baseline covariates, with a standardized mean difference of \u0026lt;\u0026thinsp;0.01.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of the Cohorts Before and After Propensity Score Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnmatched Cohort(N\u0026thinsp;=\u0026thinsp;91,158)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMatched Cohort (N\u0026thinsp;=\u0026thinsp;10,582)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIBD\u003c/b\u003e\u003csup\u003ea\u003c/sup\u003e \u003cb\u003e(N\u0026thinsp;=\u0026thinsp;962)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNon-IBD (N\u0026thinsp;=\u0026thinsp;90,196)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eIBD (N\u0026thinsp;=\u0026thinsp;962)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eNon-IBD (N\u0026thinsp;=\u0026thinsp;9,620)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSMD\u003c/b\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e510 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44,246 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e504 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,085 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e452 (47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45,950 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e451 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,535 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge distribution (y), n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,565 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e222 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,280 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e429 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,345 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,066 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e214 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21,752 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e214 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,127 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e289 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23,685 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e289 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,931 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19,819 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e235 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,281 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e80\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,393 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e557 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteonecrosis of femoral head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e521 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45,302 (50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e521 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,215 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteoarthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27,142 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e261 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,579 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral neck\u003c/p\u003e \u003cp\u003efracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,752 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e180 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,826 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear of surgery, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,686 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e788 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,838 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e585 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,043 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e808 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,164 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e826 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,595 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e692 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,057 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e906 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,478 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e918 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,016 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e969 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,717 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e985 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,926 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,060 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,676 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,061 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharlson Comobidty Index\u003c/b\u003e,\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial Infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,079 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e368 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongestive Heart Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e183 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13,358 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e183 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,793 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral vascular disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e431 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35,770 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e431 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,280 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e514 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41,625 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e514 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,083 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRheumatoid arthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e332 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24,689 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e332 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,348 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,758 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e319 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,149 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,115 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e636 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e721 (74.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60,642 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e721 (74.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,202 (75.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003cp\u003eliver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e714 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59,866 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e714 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,078 (73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Kidney Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,098 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,023 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM with\u003c/p\u003e \u003cp\u003ecomplication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14,107 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e177 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,717 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to\u003c/p\u003e \u003cp\u003esevere\u003c/p\u003e \u003cp\u003eliver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,623 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeptic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e754 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59,310 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e754 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,483 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid tumor \u003c/p\u003e \u003cp\u003ewithout metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,586 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,323 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eIBD, inflammatory bowel disease; \u003csup\u003eb\u003c/sup\u003eSMD, standardized mean difference; \u003csup\u003ec\u003c/sup\u003eSD, standard deviation;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ed\u003c/sup\u003eDM, diabetes mellitus; disease\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatients who have IBD compared to controls\u003c/h3\u003e\n\u003cp\u003ePatients who have IBD demonstrated a higher incidence of PJI compared to the controls (2.1 (n = 20) vs 1.3% (n = 121); \u003cem\u003eP\u003c/em\u003e= 0.03) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were no significant differences in other surgical complications (superficial surgical site infection (5.0 (n = 48) vs 4.3% (n = 417); \u003cem\u003eP\u003c/em\u003e= 0.34), periprosthetic fractures (1.1 (n = 11) vs 0.9% (n = 82); \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.46), both early and late dislocations (2.1 (n = 20) vs 1.6% (n = 176); \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.66), and revisions for aseptic loosening (0.3 (n = 3) vs 0.7% (n = 65); \u003cem\u003eP\u003c/em\u003e= 0.25) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Furthermore, this difference was observed only in chronic PJI, not in acute PJI between the IBD and non-IBD groups (1.8 (n = 17) vs 1.0% (n = 90); \u003cem\u003eP\u003c/em\u003e= 0.02). In addition to IBD (hazard ratio (HR): 1.87, confidence interval (CI) [1.31\u0026ndash;2.67], \u003cem\u003eP\u003c/em\u003e= 0.001), patients with DM with complications and those with chronic kidney disease were found to have a higher risk of PJI, with HRs of 1.47 (CI [1.01\u0026ndash;2.14], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04) and 1.72 (CI [1.13\u0026ndash;2.64], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Outcomes of IBD vs. Matched Non-IBD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIBD\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;962)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-IBD (N\u0026thinsp;=\u0026thinsp;9,620)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuperficial surgical site infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e417 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeriprosthetic Joint Infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcute\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDislocation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeriprosthetic Fracture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRevision for aseptic loosening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow up period, year (median [IQR])\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8 [0.8;5.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9 [0.8;5.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003eWilcoxon rank sum test; Fisher's exact test; Pearson's C\u003cem\u003ehi-\u003c/em\u003esquare test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox proportional hazards model for risk of Periprosthetic Joint Infection after total hip arthroplasty in matched cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted HR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIBD\u003c/b\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.28\u0026ndash;5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.31\u0026ndash;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u0026ndash;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAVN\u003c/b\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOA\u003c/b\u003e\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.87\u0026ndash;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemoral neck fracture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.77\u0026ndash;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMyocardial Infarction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.25\u0026ndash;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCongestive Heart Failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026ndash;3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeripheral vascular disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026ndash;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56\u0026ndash;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM with complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026ndash;3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.01\u0026ndash;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRheumatoid arthritis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48\u0026ndash;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCerebrovascular disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.52\u0026ndash;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDementia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u0026ndash;6.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiver disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.55\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic Kidney Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.08\u0026ndash;2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.13\u0026ndash;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSolid tumor without metastasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026ndash;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eHR, hazard ratio; \u003csup\u003eb\u003c/sup\u003eCI, confidence interval; \u003csup\u003ec\u003c/sup\u003eIBD, inflammatory bowel disease; \u003csup\u003ed\u003c/sup\u003eAVN, avascular necrosis; \u003csup\u003ee\u003c/sup\u003eOA, osteoarthritis; \u003csup\u003ef\u003c/sup\u003eDM, diabetes mellitus\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses restricted to patients who have IBD\u003c/h2\u003e \u003cp\u003eUnivariate analysis showed that medication use itself did not increase the risk of chronic PJI, but steroid use was a significant predictor of chronic PJI in both patients who used steroids regardless of the time of surgery (odds ratio (OR): 2.79 [1.03\u0026ndash;10.68], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04) and those who used steroids within 1 year prior to surgery (OR: 3.58 [1.33\u0026ndash;11.80], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03) (Table\u0026nbsp;5). Multivariable analysis confirmed that steroid usage within 1 year prior to surgery (OR 3.30 [1.21\u0026ndash;10.86], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02) remained a unique and significant independent predictor for chronic PJI.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study demonstrates that IBD is associated with a significantly higher risk of PJIs in patients who underwent THA, but not in those with aseptic loosening or periprosthetic fractures. Notably, the use of corticosteroids within the year preceding surgery, but not 5-ASA or anti-TNF agents, was associated with an increased risk of PJIs.\u003c/p\u003e \u003cp\u003eStudies have investigated the association between IBD and arthroplasty complications. In a single center study, Chisari et al suggested that patients who have IBD experienced higher rates of PJI and aseptic loosening compared to controls [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, Magruder et al suggested that patients who have IBD who underwent primary THA had a higher risk of implant related complications in a private insurance claims database [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although previous studies have described an increase in various implant related complications including septic loosening and PJI due to IBD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], our study found an increase in PJI only and no significant difference in other implant complications, including aseptic loosening. This correlates with another real-world data study in which Moran et al suggested that patients who have a history of IBD had a relatively high risk of revision surgery for septic causes but not for aseptic causes in the Swedish Hip Arthroplasty Registry [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, medication use was stratified among patients who have IBD to confirm its association with PJI. Previous studies have generally included patients who have IBD as a single group without distinguishing between medication usage, and few single center studies have specifically analyzed the effect of medication use on PJI [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, some studies have excluded groups of patients taking steroids from their analysis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As a result, there are limitations in generalizing findings to all patients who have IBD, an issue highlighted by our study. While the use of medication in general was not associated with PJI in patients who have IBD, the use of steroids was specifically associated with an increased risk of PJI. In patients who have IBD, steroids are typically used during acute flares, whereas 5-ASA or anti-TNF are used for maintenance [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Patients whose condition is well-controlled may not require medication. Our findings are consistent with those of Gregory et al in which anti-TNF therapy for IBD did not cause serious infections after arthroplasty [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In other words, even if a patient has IBD, there may be no complications if the condition is well-controlled. Conversely, THA may significantly increase the risk of PJI in patients who have uncontrolled IBD.\u003c/p\u003e \u003cp\u003eLimitation of this study was its reliance on registry data, which may have limited the availability of information on potential confounding factors. The data did not include details of IBD activity, symptoms, or laboratory data. However, including clinical data from sufficient centers to provide adequate authority in providing answers to our questions was not feasible. Miscoding can be a problem with administrative data; however, UC and Crohn\u0026rsquo;s disease are registered as rare diseases under special provisions. Therefore, while the possibility of misdiagnosing IBD is rare, underreporting may still occur in surgical outcomes. Another limitation was that the study did not account for the potential effect of dosage or the preoperative discontinuation status of medication, and the number of patients using anti-TNF was too small to yield statistically significant results. Also, the temporal categorization of PJI into acute and chronic was based on timeframes, which prevented the analysis of acute hematogenous infections. Furthermore, the lack of directionality specifications in the HIRA data resulted in the exclusion of bilateral surgeries from subsequent complication assessments, which could have led to a selection bias.\u003c/p\u003e \u003cp\u003eIn conclusion, this nationwide study confirmed that IBD increases the risk of chronic PJI. A sub-analysis based on medication revealed that preoperative steroid use significantly increased this risk. Conversely, well-controlled IBD did not correlate with increased surgical complications, including PJI. Therefore, it is crucial to avoid preconceptions that solely attribute PJI risk to IBD. Instead, awareness should be raised regarding the potential issues associated with steroid use in cases of uncontrolled IBD, such as acute flares. Clinical suggestions include recommending that surgeons consider the patient's IBD clinical activity at the time of surgery or when making surgical indications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e The institutional review board of our hospital approved the design and protocol of this study (2023AN0470). The requirement for informed consent was waived due to the retrospective design of the study\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the Korea Medical Device Development Fund grant funded by the Korea government (Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health \u0026amp; Welfare, the Ministry of Food and Drug Safety) (IRIS No. RS-2020-KD000038), which was allocated for data extraction expenses.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHong served as the first author, contributing to the overall drafting of the manuscript, performing data analysis, and overseeing the preparation of tables and figures. Yu was responsible for statistical analysis, providing critical input on methodology, and interpreting the results. Han, as the corresponding author, supervised the study, revised the manuscript for important intellectual content, and contributed to the conceptual framework of the research. All authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was supported by the Korea Medical Device Development Fund grant funded by the Korea government (Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health \u0026amp; Welfare, the Ministry of Food and Drug Safety) (IRIS No. RS-2020-KD000038), which was allocated for data extraction expenses.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePark S-K, Wong Z, Park SH, Van Vu K, Bang KB, Piyachaturawat P, Myint T, Hilmi I, Park D-I (2021) Extraintestinal manifestation of inflammatory bowel disease in Asian patients: a multinational study. Dig Liver Disease 53:196\u0026ndash;201\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOssum AM, Palm \u0026Oslash;, Cvancarova M, Solberg IC, Vatn M, Moum B, H\u0026oslash;ivik ML, group Is (2018) Peripheral arthritis in patients with long-term inflammatory bowel disease. Results from 20 years of follow-up in the IBSEN study. Scand J Gastroenterol 53:1250\u0026ndash;1256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogler G, Singh A, Kavanaugh A, Rubin DT (2021) Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disease management. Gastroenterology 161:1118\u0026ndash;1132\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCompston J, Judd D, Crawley E, Evans W, Evans C, Church H, Reid E, Rhodes J (1987) Osteoporosis in patients with inflammatory bowel disease. 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Inflamm Bowel Dis 13:42\u0026ndash;50\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoftus EV Jr, Crowson CS, Sandborn WJ, Tremaine WJ, O'Fallon WM, Melton LJ III (2002) Long-term fracture risk in patients with Crohn's disease: a population-based study in Olmsted County. Minn Gastroenterol 123:468\u0026ndash;475\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEhrenpreis ED, Zhou Y (2017) Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease. World J Gastroenterol 23:4752\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagruder ML, Hidalgo Perea S, Gordon AM, Ng MK, Wong CHJ (2023) The Association of Inflammatory Bowel Disease with Postoperative Complications, Re-admissions and Emergency Department Visits Following Primary Total Hip Arthroplasty. HIP International:11207000231216106\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim DJ, Tischler EH, Kong RM, Nehme F, Dolphin EJ, Ho ES, Lescaille Y, Naziri Q (2022) Crohn\u0026rsquo;s disease in total knee arthroplasty patients correlates with increased rates of 90-day and overall postoperative complications and readmissions. Knee 34:238\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoran MM, Wessman P, Rolfson O, Bohl DD, K\u0026auml;rrholm J, Keshavarzian A, Sumner DR (2021) The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study. PLoS ONE 16:e0257310\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemily EA, Sax OC, Douglas SJ, Salib CG, Salem HS, Mon\u0026aacute;rrez RG, Delanois RE (2023) Inflammatory bowel disease is associated with increased complications after total knee arthroplasty. Knee 40:313\u0026ndash;318\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu D, Ding C, Cheng T, Yang C, Zhang X (2023) Inflammatory bowel disease is associated with an increased risk of adverse events in patients undergoing joint arthroplasty: a meta-analysis of observational studies. Bone Joint Res 12:362\u0026ndash;371\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapadia BH, Issa K, Nagrare N, Pivec R, Banerjee S, Mont MA (2014) Higher revision and complication rates following total hip arthroplasty in patients with inflammatory bowel disease. J Arthroplast 29:596\u0026ndash;600\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChisari E, D\u0026rsquo;Mello D, Sherman MB, Parvizi J (2022) Inflammatory bowel diseases increase the risk of periprosthetic joint infection. JBJS 104:160\u0026ndash;165\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim L, Kim J-A, Kim S (2014) A guide for the utilization of health insurance review and assessment service national patient samples. Epidemiol health 36\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim J-A, Yoon S, Kim L-Y, Kim D-S (2017) Towards actualizing the value potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data. J Korean Med Sci 32:718\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark C, Jang S, Jang S, Ha Y-C, Lee Y-K, Yoon H-K, Shin CS, Kim D-Y, Lee S-s, Choi HJ (2010) Identification and validation of osteoporotic hip fracture using the national health insurance database. J Korean Hip Soc 22:305\u0026ndash;311\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim S-H, Jang S-Y, Cha Y, Kim B-Y, Lee H-J, Kim G-O (2024) Comparative Interrupted Time Series Analysis of Direct Medical Expense and Length of Stay in Elderly Patients with Femoral Neck Fractures Who Underwent Total Hip Arthroplasty and Hemiarthroplasty: A Real World Nationwide Database Study. Clin Orthop Surg 16:217\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim SS, Lee W, Kim YK, Kim J, Park JH, Park BR, Yoon JH (2019) The cumulative incidence and trends of rare diseases in South Korea: a nationwide study of the administrative data from the National Health Insurance Service database from 2011\u0026ndash;2015. Orphanet J Rare Dis 14:1\u0026ndash;16\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagruder ML, Parsa S, Gordon AM, Ng M, Wong CHJ (2023) Inflammatory bowel disease patients undergoing total hip arthroplasty have higher odds of implant-related complications. HIP Int :11207000231214768\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadid B, Buehring W, Mannino A, Weisberg MD, Golub IJ, Ng MK, Razi AE (2023) Crohn's Disease Increases In-Hospital Lengths of Stay, Medical Complications, and Costs of Care following Primary Total Knee Arthroplasty. J Knee Surg 36:524\u0026ndash;529\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaljee AK, Wiitala WL, Govani S, Stidham R, Saini S, Hou J, Feagins LA, Khan N, Good CB, Vijan S (2016) Corticosteroid use and complications in a US inflammatory bowel disease cohort. PLoS ONE 11:e0158017\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGregory MH, McKinnon A, Stwalley D, Hippensteel KJ, Loftus EV Jr, Ciorba MA, Olsen MA, Deepak P (2019) Anti-tumour necrosis factor therapy for inflammatory bowel diseases do not impact serious infections after arthroplasty. J Crohn's Colitis 13:182\u0026ndash;188\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Inflammatory bowel disease, Total hip arthroplasty, Periprosthetic joint infection, Nationwide study, Preoperative steroid use","lastPublishedDoi":"10.21203/rs.3.rs-5669146/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5669146/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eThis study investigated the association between medication status and total hip arthroplasty (THA) complications in patients who have inflammatory bowel disease (IBD), considering varying illness severities.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThis retrospective analysis of the National Health Insurance Review and Assessment Service database in South Korea, included patients undergoing unilateral THA between 2012\u0026ndash;2022, specifically those diagnosed with IBD. Propensity score matching was used to adjust for baseline characteristics between IBD and non-IBD cohorts, with a matching ratio of 1:10.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a significant difference between the IBD (n\u0026thinsp;=\u0026thinsp;962) and non-IBD matched groups (n\u0026thinsp;=\u0026thinsp;9,620) in terms of chronic periprosthetic joint infection (PJI) (2.1 vs 1.3%, \u003cem\u003eP\u003c/em\u003e= 0.03) but not with acute PJI or other surgical complications (periprosthetic fracture, dislocation, and aseptic loosening). Medication use itself was not associated with PJI, except for corticosteroid use, significantly associated with PJI among IBD medications (OR: 2.79 [1.03\u0026ndash;10.68], P\u0026thinsp;=\u0026thinsp;0.04). Multivariable analysis indicated a significant increase in PJI risk with corticosteroid use within one year before THA (OR: 3.30 [1.21\u0026ndash;10.86], P\u0026thinsp;=\u0026thinsp;0.01). Patients not using steroids did not exhibit an inherent risk of IBD related complications.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis nationwide study confirmed that IBD increases the risk of chronic PJI. Preoperative corticosteroid use within the year before arthroplasty significantly increased the risk of PJI, particularly in patients with poorly controlled IBD and acute flares-up. Conversely, well-controlled IBD did not correlate with increased surgical complications. Attention should be directed towards recognizing the risk of steroid use, such as acute flares in cases of uncontrolled IBD, to optimize preoperative treatment for IBD undergoing arthroplasty.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel III, Prognostic\u003c/p\u003e","manuscriptTitle":"Does Inflammatory Bowel Disease Elevate Infection Risk in Total Hip Arthroplasty? Insights from a nationwide study highlighting steroid use as the key determinant","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-26 06:07:24","doi":"10.21203/rs.3.rs-5669146/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-15T09:29:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-03T02:50:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27923511013867238946435682969102824443","date":"2024-12-22T08:40:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-12-19T10:44:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-18T12:49:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-12-18T12:49:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Orthopaedic and Trauma Surgery","date":"2024-12-18T11:37:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e52e72d2-0fdb-44bd-a428-44fb41bb682e","owner":[],"postedDate":"December 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:12:41+00:00","versionOfRecord":{"articleIdentity":"rs-5669146","link":"https://doi.org/10.1007/s00402-025-06094-2","journal":{"identity":"archives-of-orthopaedic-and-trauma-surgery","isVorOnly":false,"title":"Archives of Orthopaedic and Trauma Surgery"},"publishedOn":"2025-10-14 15:58:45","publishedOnDateReadable":"October 14th, 2025"},"versionCreatedAt":"2024-12-26 06:07:24","video":"","vorDoi":"10.1007/s00402-025-06094-2","vorDoiUrl":"https://doi.org/10.1007/s00402-025-06094-2","workflowStages":[]},"version":"v1","identity":"rs-5669146","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5669146","identity":"rs-5669146","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}