Increased Risk of Periprosthetic Joint Infections in Patients With Hypothyroidism Undergoing Total Joint Arthroplasty

Background: Although thyroxine has an important role in modulating the immune system, it has not been associated with periprosthetic joint infection. This study was conceived to examine the association between hypothyroidism and periprosthetic joint infection (PIJ). Methods: Using an institutional database, the preoperative comorbidities of 32,289 total joint arthroplasties performed between 2000 and 2013 were identified using an International Classification of Diseases, Ninth Revision-based comorbidity index. Results: In the multivariate analysis, hypothyroidism was found to be an independent risk factor (adjusted odds ratio: 2.46; P < .0001). In addition, patients who developed PJI demonstrated higher thyroid-stimulating hormone levels than those without (P = .04). Discussion: Surgeons should be aware of this increased risk of PJI in hypothyroid patients when risk stratifying, and future studies are needed to determine the potential role of thyroxine supplementation. (C) 2016 Elsevier Inc. All rights reserved.