Ileus, Gastrointestinal Bleeding and Clostridium difficile Colitis after Hip and Knee Replacement - a Systematic Review.

Introduction: Major gastrointestinal complications after arthroplasty are rare, but can have detrimental effects on the patient and can substantially increase the overall cost of treatment. This systematic review provides an overview of ileus, gastrointestinal bleeding and C. difficile colitis after total hip and knee arthroplasty.

Materials And Methods: We followed the PRISMA guidelines and searched 3 databases for the period between 1 January 2000 and 31 December 2018. The manual search included references in retrieved articles. We extracted data on the cohort size, study level, arthroplasty procedure, complications and their incidence, and recommendations by the study.

Results: Twenty-five studies that analyzed these complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified. These complications have an incidence of up to 2% each. According to some of the studies, an incidence of 0% is possible. While the risk factors for ileus varied greatly, those for C. difficile colitis were more consistent. There are some recommendations for reducing the incidence of ileus and C. difficile. This heterogeneity does not allow us to draw any conclusion regarding which thromboprophylaxis agent has the lowest incidence of gastrointestinal bleeding.

Conclusion: The complications investigated in this systematic review are rare and have a reported incidence of up to 2% each. Even though there are some recommendations for reducing the complication rate, due to the complex nature of the arthroplasty setting, there is a need for further investigation of these risk factors and how they can be reduced.