The Impact of Hepatitis C on Short-Term Outcomes of Total Joint Arthroplasty

Abstract

Infection with hepatitis C is an infrequent but increasingly common comorbidity among patients undergoing total joint arthroplasty. Given these findings, orthopaedic surgeons should be aware of the increased risks of total joint arthroplasty in patients with hepatitis C and should discuss these risks with potential surgical candidates during a shared decision-making process.

Is Hepatitis C Infection Associated With a Higher Risk of Complications After Total Shoulder Arthroplasty?

“…Hepatitis C is associated with an increased risk for complications in these patients after TSA, including infection, dislocation, fracture, revision TSA, systemic complications, and blood transfusion compared with ageand sex-matched control subjects. These findings are consistent with those in the lower-extremity arthroplasty literature that also have showed an association between a patient's hepatitis C status and the increased risk of postoperative complications [3,8]. In a recent study by Issa et al [8], the National Inpatient Sample database was used to identify more than 8044 patients who underwent either THA or TKA and compared them with a matched control cohort of patients without hepatitis C undergoing the same procedures.…”

“…These findings are consistent with those in the lower-extremity arthroplasty literature that also have showed an association between a patient's hepatitis C status and the increased risk of postoperative complications [3,8]. In a recent study by Issa et al [8], the National Inpatient Sample database was used to identify more than 8044 patients who underwent either THA or TKA and compared them with a matched control cohort of patients without hepatitis C undergoing the same procedures. Compared with matched control subjects, patients with hepatitis C had a 30% increased risk of any complication, a 15% increased risk of a medical complication, and 78% increased risk of a surgical complication.…”

“…Although the association between a patient's hepatitis C status and the increased risk of postoperative bleeding, acute postoperative infection, and general medical complications have been studied in patients undergoing lower-extremity arthroplasty [3,8], no studies of which we are aware have investigated the subset of patients undergoing TSA with hepatitis C. Our study suggests that patients with hepatitis C are at an increased risk for complications after TSA, including infection, dislocation, fracture, revision TSA, systemic complications, and blood transfusion, compared with matched control subjects. This study has several limitations.…”

“…Although the prevalence of hepatitis C infection among patients undergoing orthopaedic surgery has been estimated to be from 3% to 8%, studies in the setting of lowerextremity arthroplasty have reported an increase in the number of patients with hepatitis C undergoing lower-extremity total joint arthroplasty during the last decade [4,8]. Furthermore, these studies raise concerns regarding the apparent increase in postoperative complications in patients with hepatitis C compared with those without the virus.…”

“…Furthermore, these studies raise concerns regarding the apparent increase in postoperative complications in patients with hepatitis C compared with those without the virus. Recent lower-extremity arthroplasty literature has shown a significant increase in the odds of acute postoperative infection, mechanical complications, allogenic blood transfusion, and general medical and systemic complications [3,8]. This is likely attributable to the complex pathophysiology of hepatitis C infection and its association with several extrahepatic manifestations that likely contribute to the described increase in perioperative complications including hepatitis, membranoproliferative glomerulonephritis, leukocytoclastic vasculitis, and thrombocytopenia [1,10,12,14,16,17,22].…”