The gut-Joint axis: investigating functional gastrointestinal disorders as risk factors for prosthetic joint infections a retrospective case-control study

Background Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), with traditional risk factors including diabetes and obesity. Emerging evidence suggests functional gastrointestinal disorders (FGIDs) may influence systemic inflammation and infection susceptibility. This study investigated whether preexisting FGIDs are independent risk factors for PJI.Methods A retrospective 1:1 matched case-control study analyzed 896 patients (448 PJI vs. 448 non-PJI) undergoing primary TJA (2013–2023). PJI was diagnosed using modified 2018 Musculoskeletal Infection Society criteria, and FGIDs (irritable bowel syndrome [IBS], functional diarrhea [FD], functional constipation [FC]) were classified per Rome IV criteria. Multivariable logistic regression identified PJI risk factors after adjusting for demographics, comorbidities, and surgical variables.Results Univariate analysis revealed significantly higher FC prevalence in PJI cases (14.3% vs. 8.3%, p = 0.0043), while IBS and FD showed no association. Multivariate analysis confirmed FC as an independent PJI risk factor (odds ratio [OR] = 1.844, 95% confidence interval [CI]:1.199–2.872, p = 0.0059), alongside diabetes (OR = 1.714, 95%CI:1.116–2.661, p = 0.0148), and surgery duration >2 hours (OR = 2.220, 95%CI:1.242–4.125, p = 0.0088). Perioperative antibiotic usage reduced PJI risk (OR = 0.405, 95%CI:0.232–0.686, p = 0.0010).Conclusion Functional constipation was identified as a novel independent risk factor for PJI, alongside established metabolic comorbidities and prolonged surgery. These findings underscore the gut-joint axis in PJI pathogenesis and advocate integrating FGID screening into preoperative risk stratification. Antibiotic prophylaxis remains critical for minimizing infection risk in TJA patients.