Title : Psoriasis as an independent risk factor for postoperative infections and revision surgeries in joint arthroplasty: A systematic review and meta-analysis
Abstract:
Psoriasis, a chronic systemic inflammatory disease, is associated with immune dysregulation and comorbidities that may increase complications following joint arthroplasty. Despite the well-documented impact of other inflammatory joint diseases, the role of psoriasis as a risk factor for postoperative infections and revision surgeries has been underexplored. The objective of this study evaluates psoriasis as an independent risk factor for postoperative infections and revision surgeries in patients undergoing joint arthroplasties, including total hip arthroplasty (THA), total knee arthroplasty (TKA), and other joint arthroplasties (OJA).
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Eligible studies compared patients with psoriasis or psoriatic arthritis (PsA) to controls without psoriasis, focusing on infection and revision surgery rates. Data were pooled using random-effects models to calculate risk ratios (RR) and odds ratios (OR), and heterogeneity was assessed using I² statistics.
Ten studies involving 4,442,349 patients were included. Psoriasis significantly increased the risk of postoperative infections (RR: 2.27; 95% CI: 1.61–3.22; p<0.001; OR: 1.76; 95% CI: 1.34–2.32; p<0.001) and revision surgeries (RR: 1.31; 95% CI: 0.85–2.00; p=0.22; OR: 1.60; 95% CI: 1.50–1.70; p<0.001). Subgroup analyses showed consistent infection risks across arthroplasty types, with the highest risk observed in THA (RR: 3.07; 95% CI: 1.25–7.54; OR: 1.87; 95% CI: 0.98–3.56). Similarly, psoriasis significantly increased revision risks in TKA (OR: 1.60; 95% CI: 1.50–1.71) and OJA (OR: 1.51; 95% CI: 1.01–2.26).
Psoriasis independently elevates the risk of postoperative infections and revisions following joint arthroplasties. These findings underscore the need for tailored perioperative care, including enhanced infection prevention strategies and multidisciplinary management for patients with psoriasis undergoing joint replacement surgery. Further research should explore the mechanisms underlying these associations and optimize surgical outcomes for this patient population.
