Background: Proton pump inhibitors (PPI) increase the risk of osteoporotic fractures, fracture non-unions and infections. Their use perioperatively has been shown previously to increase the risk of periprosthetic joint infection (PJI), however, the body evidence supporting this is small. Here we present our own cohort study examining the effects of PPIs on the risk of PJI. 

Method: A cohort of 1,504 primary total hip (THA) and total knee arthroplasties (TKA) were identified at a single centre. A PJI group and control group were generated with ICD-10 codes used to confirm the diagnosis of PJI. Hospital discharge and medication records were used to establish the use of PPIs in the perioperative setting. 

Results: 23 confirmed cases of PJI were identified and a control group of 100 cases was generated. Demographics were statistically similar between the two groups. 6 of the 23 PJI cases (26%) used PPIs perioperatively compared to 24 control cases (24%) (p = 0.412)

Conclusion: There was no increased risk of PJI with the perioperative use of PPIs in our study. There is sparce evidence in the literature to conclusively support the cessation of PPIs in the lead up to arthroplasty surgery. Further high-quality studies need to be conducted in this area in order to develop a concrete conclusion surrounding PPI use surrounding arthroplasty.

Zachary Sinagra is a surgical registrar (international equivalent to resident) in orthopaedic surgery in Perth, Western Australia. Dr Sinagra studied anatomy and sports science (BSc) at the University of Western Australia prior to completing his Bachelor of Medicine, Bachelor of Surgery (MBBS) at the University of Notre Dame, Fremantle, in 2014. In 2023, he completed a Master of Surgery (MS) by thesis at the University of Western Australia. So far, he has published five articles in international journals and has a keen interest in research and teaching.