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

Ilya Bendich, Steven Takemoto, Joseph T. Patterson, Alexander Monto, Thomas C. Barber, Alfred C. Kuo

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

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.

Original languageEnglish
Pages (from-to)S319-S326.e1
JournalJournal of Arthroplasty
Volume34
Issue number7
DOIs
StatePublished - Jul 2019

Keywords

  • complications
  • infection
  • preoperative optimization
  • total hip arthroplasty
  • total knee arthroplasty

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