The preoperative management of Hepatitis C may improve the outcome after total knee arthroplasty

Abstract

Aims With an ageing population of patients who are infected with hepatitis C virus (HCV), the demand for total knee arthroplasty (TKA) in this high-risk group continues to grow. It has previously been shown that HCV infection predisposes to poor outcomes following TKA. However, there is little information about the outcome of TKA in patients with HCV who have been treated successfully. The purpose of this study was to compare the outcomes of TKA in untreated HCV patients and those with HCV who have been successfully treated and have a serologically confirmed remission. Patients and Methods A retrospective review of all patients diagnosed with HCV who underwent primary TKA between November 2011 and April 2018 was conducted. HCV patients were divided into two groups: 1) those whose HCV was cured (HCV-C); and 2) those in whom it was untreated (HCV-UT). All variables including demographics, HCV infection characteristics, surgical details, and postoperative medical and surgical outcomes were evaluated. There were 64 patients (70 TKAs) in the HCV-C group and 63 patients (71 TKAs) in the HCV-UT cohort. The mean age at the time of surgery was 63.0 years (sd 7.5; 44 to 79) in the HCV-C group and 61.7 years (sd 6.9; 47 to 88) in the HCV-UT group. Results HCV-UT patients had a significantly longer mean hospital stay (3.4 days vs 2.9 days; p = 0.04), were more likely to be transferred to the intensive care unit (14.1% vs 4.3%; p = 0.04), and were significantly more often discharged to a post-acute care facility (39.4% vs 14.3%; p < 0.01). HCV-UT patients had significantly more postoperative infections (15.5% vs 4.3%; p = 0.03), surgical complications (21.1% vs 7.1%; p = 0.02), and revision TKA (12.7% vs 1.4%; p < 0.01) than HCV-C patients. Conclusion The preoperative treatment of HCV can reduce the risk of complications, including prosthetic joint infection and revision TKA. We recommend that HCV treatment regimens should be integrated into the preoperative optimization protocol for this high-risk group of patients. Cite this article: Bone Joint J 2019;101-B:667–674.

Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load

“…We noted that nearly 45% of our patient cohort (125 TJA cases) did not receive treatment and had PVL when undergoing TJA, and many of them refused treatment due to the limitations and side effects of interferon. That being said, patients undergoing TJA treated with DAAs do not have lower medical or surgical complications, PJI, and revision TJA rates for mechanical causes than those treated with interferon [ 25 ]. In our study, patients receiving interferon or DAAs achieved high UVL rates, and the type of treatment was not a significant risk factor for developing PJI.…”

“…Schwarzkopf et al. found that liver fibrosis is more prevalent in patients who received treatment for HCV than in those not treated, indicating that treatment was preferentially given to those patients with advanced disease [ 25 ]. We identified a similar trend in our cohort.…”

The Impact of Hepatitis C on Complication Rates After Revision Total Knee Arthroplasty: A Matched Cohort Study

“…As these patients often have more comorbidities than most patients undergoing an rTKA and higher comorbidity burdens are associated with an increased complication risk [ [41] , [42] , [43] , [44] ], medical optimization before an rTKA is critical in this population. Recent analyses have reported improved outcomes after a primary arthroplasty in patients with HCV who received preoperative antiviral treatment [ 16 , [45] , [46] , [47] ]. It is likely that similar interventions before an rTKA also decrease the complication risk in this population.…”

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

“…It was not until 2019 that Medicaid in Louisiana expanded to include hepatitis C treatment for all patients [39]. Recent studies demonstrate the possible benefits associated with treatment of hepatitis C [11,40,41]. Future studies should examine the effects of treated vs untreated hepatitis C patients using a very large patient population examining complications using clinical and ICD coding data.…”