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J Arthroplasty. 2019 Dec;34(12):2890-2897. doi: 10.1016/j.arth.2019.06.058. Epub 2019 Jul 2.

Undetectable Hepatitis C Viral Load Is Associated With Improved Outcomes Following Total Joint Arthroplasty.

Author information

1
Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, New York, NY; Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
2
Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, New York, NY.
3
Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY.
4
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
5
Department of Orthopaedic Surgery, Duke University, Durham, NC.

Abstract

BACKGROUND:

Previous reports establish that infection with hepatitis C virus (HCV) predisposes total joint arthroplasty (TJA) recipients to poor postoperative outcomes. The purpose of the present study is to assess whether variation in HCV VL influences perioperative outcomes following TJA.

METHODS:

A multicenter retrospective review of all patients diagnosed with HCV who underwent primary TJA between January 2005 and April 2018 was conducted. Patients were stratified into 2 cohorts: (1) patients with an undetectable VL (U-VL) and (2) patients with a detectable VL (D-VL). Kaplan-Meier survivorship analysis was calculated with revision TJA as the end point. Subanalysis on the VL profile was done.

RESULTS:

A total of 289 TJAs were included (U-VL:118 TJAs; D-VL:171 TJAs). Patients in the D-VL cohort had longer operative times (133.9 vs 109.2 minutes), higher intraoperative blood loss (298.4 vs 219.5 mL), longer inpatient hospital stays (4.0 vs 2.9 days), more postoperative infections (11.7% vs 4.2%), and an increased risk for revision TJA (12.9% vs 5.1%). Kaplan-Meier demonstrated that the U-VL cohort trended toward better survivorship (P = .17). On subanalysis of low and high VL, no difference in outcomes was appreciated.

CONCLUSION:

TJA recipients with a detectable HCV VL have longer operative times, experience more intraoperative blood loss, have longer hospital length of stay, and are more likely to experience infection and require revision TJA. The blood loss, hospital length of stay, and revision rate findings should be interpreted with caution, however, as there are confounding factors. Our findings suggest that HCV VL is a modifiable risk factor that, can reduce the risk of infection and revision surgery. Additionally, serum HCV VL was not correlated with outcomes.

KEYWORDS:

hepatitis C; periprosthetic infections; postoperative outcomes; total joint arthroplasty; viral load

PMID:
31351854
DOI:
10.1016/j.arth.2019.06.058

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