Preoperative Treatment of Hepatitis C Is Associated With Lower Prosthetic Joint Infection Rates in US Veterans

Abstract

BACKGROUND: 

Hepatitis C virus (HCV) is associated with poorer outcomes in total joint arthroplasty (TJA). Recently, oral direct-acting antivirals (DAAs) have become available for HCV curative treatment. The goal of this study is to determine if HCV may be a modifiable risk factor in TJA by comparing postoperative complications among patients with and without preoperative treatment for HCV.

 

METHODS: 

US Department of Veterans Affairs dataset of all consecutive primary TJAs performed between 2014 and 2018, when DAAs were available, was retrospectively reviewed. HCV-infected patients were identified using International Classification of Diseases, Ninth and Tenth Revision codes and laboratory values. HCV-infected patients treated prior to TJA with DAA were included in the "treated" group. HCV-infected patients untreated preoperatively were assigned to the "untreated" group. Medical and surgical complications up to 1 year postoperatively were identified using International Classification of Diseases, Ninth and Tenth Revision inpatient and outpatient codes.

 

RESULTS: 

In total, 42,268 patients underwent TJA at Veterans Affairs Hospitals between 2014 and 2018. About 6.0% (n = 2557) of TJA patients had HCV, 17.3% of whom received HCV treatment preoperatively. When evaluating inpatient and outpatient codes, implant infection rates were statistically lower at 90 days and 1 year postoperatively among HCV-treated patients than among those untreated. Odds ratios (ORs) favor lower infection rates in HCV-treated patients (90-day OR: 3.30, P = .045; 1-year OR: 2.16, P = .07).

 

CONCLUSION: 

Preoperative HCV treatment was associated with lower periprosthetic infection rates among US veterans undergoing TJA. Further investigation is necessary for definitive conclusions.

Authors

Bendich I1, Takemoto S2, Patterson JT1, Monto A3, Barber TC1, Kuo AC2.

 

J Arthroplasty. 2019 Mar 9. pii: S0883-5403(19)30208-6. doi: 10.1016/j.arth.2019.02.052. [Epub ahead of print]

Author Information

  1. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.

  2. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA; Department of Orthopaedic Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA.

  3. Department of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, CA.

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