title: Increased Risk of Periprosthetic Joint Infections in Patients With Hypothyroidism Undergoing Total Joint Arthroplasty.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Tan
authors.affiliation: Department of Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Haran
authors.initials: H
authors.lastname: Rajeswaran
authors.affiliation: Department of Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Sleiman
authors.initials: S
authors.lastname: Haddad
authors.affiliation: Department of Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Alisina
authors.initials: A
authors.lastname: Shahi
authors.affiliation: Department of Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002648:Child; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications*; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: arthroplasty; hypothyroidism; infection; revision; risk factors