The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

Salomon, Brett; Krause, Peter C.; Dasa, Vinod; Shi, Lizheng; Jones, Deryk G.; Chapple, Andrew G.

doi:10.1016/j.artd.2020.12.016

Cited by 6 publications

(9 citation statements)

References 38 publications

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“…The defective immune responses due to poor complement system and opsonization sufficiency, portosystemic shunt and bacterial intestinal overgrowth render the patients prone to infections like septic arthritis, osteomyelitis, cellulitis and necrotizing fasciitis[ 14 ]. Finally, sarcopenia[ 15 ], non-traumatic osteonecrosis[ 16 ] and a higher rate of periprosthetic complications[ 17 ] are manifestations from the musculoskeletal system that compromise severely the quality of a patient’s life.…”

Section: To the Editormentioning

confidence: 99%

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Tsagkaris¹,

Papadakos²,

Moysidis³

et al. 2022

WJGP

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Chronic liver disease can affect many body systems including the musculoskeletal system. The pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology, such as the hepatorenal syndrome. Nevertheless, the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to date. Because of this shortage, documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is challenging. To fill this gap, the authors propose the term hepatomusculoskeletal disorders, a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.

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Section: To the Editormentioning

confidence: 99%

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Tsagkaris¹,

Papadakos²,

Moysidis³

et al. 2022

WJGP

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“…32 Patients undergoing TJA with hepatitis C have been shown to have an increased risk of surgical complications. 33,34 Untreated patients have more postoperative infections, aseptic loosening, medical complications, and revision surgery. 31,[35][36][37][38] Therefore, hepatitis C presents a notable risk of poor outcomes, and evidence that treatment reduces the risks of complications explains the importance of preoperative assessment and optimization.…”

Section: Hepatitis and Disparitiesmentioning

confidence: 99%

Movement is Life—Optimizing Patient Access to Total Joint Arthroplasty: HIV and Hepatitis C Disparities

Wiznia

Morgan

Gibson

2021

J Am Acad Orthop Surg

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This article is one of a series focusing on how the preoperative optimization process, if designed for underserved communities, can improve access to care and reduce disparities. In this article, we specifically focus on methods to improve optimization for patients with HIV and hepatitis C to facilitate their access to total joint arthroplasty. 1.2 million Americans are currently living with HIV (people living with HIV). African Americans and Hispanics account for the largest proportion of new HIV diagnoses and make up the highest proportion of people living with HIV. HIV-positive patients, many of them with complex comorbidities, are at a high risk for postoperative complications. Optimization of this vulnerable cohort involves a multidisciplinary strategy focusing on optimizing treatment modalities to reduce viral loads, leading to lower complication rates and a safer environment for the surgical team. The rates of hepatitis C have been increasing in the United States, and more than half of individuals living with hepatitis C are unaware that they are infected. Hepatitis C infections are highest in African Americans, and the rates of chronic hepatitis C are highest in those born outside the United States. Patients with hepatitis C have an increased risk for surgical complications after total joint arthroplasty, and studies have demonstrated that these risks normalize when patients are preoperatively screened and treated. Optimization in these vulnerable groups includes working closely with psychosocial resources, the primary care team, and infectious disease specialists to ensure treatment access and compliance. Providing patients support to optimize their HIV and hepatitis C comorbidities is an important step in safe and successful arthroplasty surgery. In this article, we review the healthcare disparities associated with HIV and hepatitis C, discuss the clinical implications of HIV and hepatitis C on total joint arthroplasty of the hip and knee (TJA) outcomes, and provide strategies to optimize the clinical condition to reduce disparities. Patients with

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“…Orthopaedic studies recently conducted on patients with HCV undergoing elective TJA have focused either on early postoperative outcomes including in-hospital complications and readmissions for mechanical or infectious etiologies in matched case-control studies [23] or the outcomes of treating HCV with antiviral medications to achieve a negative viral load compared with untreated patients, with limited emphasis on early mortality and its risk factors [8,25]. Other investigations have used large-registry databases either on the state or national level to assess the impact of HCV on early postoperative complication risks within 90 days and 1 year of surgery, with a specific emphasis on reoperation for PJI, which is the most morbid complication sustained postoperatively [12,15,27]. However, these large registries, including the Medicare or Nationwide Inpatient Sample database, lack granularity and detailed information specifically about liver-related variables, characteristics, treatments used, and viral loads that are confounding and necessary when investigating early mortality after TJA in patients with HCV.…”

Section: Introductionmentioning

confidence: 99%

Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Cichos

Jordan

Niknam

et al. 2023

Clin Orthop Relat Res

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Background Patients with hepatitis C virus (HCV) undergoing primary elective total joint arthroplasty (TJA) are at increased risk of postoperative complications. Patients with chronic liver disease and cirrhosis, specifically Child-Pugh Class B and C, who are undergoing general surgery have high 2-year mortality risks, approaching 60% to 80%. However, the role of Child-Pugh and Model for End-Stage Liver Disease classifications of liver status in predicting survivorship among patients with HCV undergoing elective arthroplasty has not been elucidated. Question/purpose What factors are independently associated with early mortality (< 2 years) in patients with HCV undergoing arthroplasty? Methods We performed a retrospective study at three tertiary academic medical centers and identified patients with HCV undergoing primary elective TJA between January 2005 and December 2019. Patients who underwent revision TJA and simultaneous primary TJA were excluded. A total of 226 patients were eligible for inclusion in the study. A further 25% (57) were excluded because they were lost to follow-up before the minimum study requirement of 2 years of follow-up or had incomplete datasets. After the inclusion and exclusion criteria were applied, the final cohort consisted of 75% (169 of 226) of the initial patient population eligible for analysis. The mean follow-up duration was 53 ± 29 months. We compared confounding variables for mortality between patients with early mortality (16 patients) and surviving patients (153 patients), including comorbidities, HCV and liver characteristics, HCV treatment, and postoperative medical and surgical complications. Patients with early postoperative mortality were more likely to have an associated advanced Child-Pugh classification and comorbidities including peripheral vascular disease, end-stage renal disease, heart failure, and chronic obstructive pulmonary disease. However, both groups had similar 90-day and 1-year medical complication risks including myocardial infarction, stroke, pulmonary embolism, and reoperations for periprosthetic joint infection and mechanical failure. A multivariable regression analysis was performed to identify independent factors associated with early mortality, incorporating all significant variables with p < 0.05 present in the univariate analysis. Results After accounting for significant variables in the univariate analysis such as peripheral vascular disease, end-stage renal disease, heart failure, chronic obstructive pulmonary disease, and liver fibrosis staging, Child-Pugh Class B or C classification was found to be the sole factor independently associated with increased odds of early (within 2 years) mortality in patients with HCV undergoing elective TJA (adjusted odds ratio 29 [95% confidence interval 5 to 174]; p < 0.001). The risk of early mortality in patients with Child-Pugh Class B or C was 64% (seven of 11) compared with 6% (nine of 158) in patients with Child-Pugh Class A (p < 0.001). Conclusion Patients with HCV and a Child-Pugh Class B or C at the time of elective TJA had substantially increased odds of death, regardless of liver function, cirrhosis, age, Model for End-Stage Liver Disease level, HCV treatment, and viral load status. This is similar to the risk of early mortality observed in patients with chronic liver disease undergoing abdominal and cardiac surgery. Surgeons should avoid these major elective procedures in patients with Child-Pugh Class B or C whenever possible. For patients who feel their arthritic symptoms and pain are unbearable, surgeons need to be clear that the risk of death is considerably elevated. Level of Evidence Level III, therapeutic study.

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The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

Cited by 6 publications

References 38 publications

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

Movement is Life—Optimizing Patient Access to Total Joint Arthroplasty: HIV and Hepatitis C Disparities

Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

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