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Performing total joint arthroplasty in patients with hepatitis C may lead to complications
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Patients with hepatitis C – even those who are asymptomatic – must be counseled about the potential for higher complication and failure rates before they agree to total joint arthroplasty, according to the results of a matched-control study.
The findings were presented by Aidin Eslam Pour, MD, at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.
Pour and his team investigated the impact of hepatitis C upon the outcomes of total joint arthroplasty.
“Little is known and published about the outcome of joint arthroplasty in non-cirrhotic hepatitis C patients,” Pour said. “The goal of our study was to evaluate the outcome of hip and knee replacement in patients with seropositive, but clinically asymptomatic, hepatitis C infection.”
A matched-control study
The team performed a matched-control study of all patients with hepatitis C who underwent total joint arthroplasty between 1995 and 2007 at a single institution. The patients had a minimum follow-up of 2 years. The investigators evaluated all clinical and radiographic records of the patients and noted the details of any complications using a prospective database.
In all, 53 hips and 44 knees were replaced in 87 patients with hepatitis C during the study period. The mean age for the total hip arthroplasty (THA) group was 55 years, and the mean age in the total knee arthroplasty (TKA) group was 53 years.
Pour also noted that five patients in the THA group and six patients in the TKA group were also HIV positive. Additionally, five patients in the THA group and 11 patients in the TKA group had hemophilia.
Complications inherent
According to Pour, the incidence of complications, reoperations and revision arthroplasty was significantly higher in patients with hepatitis C when compared to the control group. In particular, he added, that these patients were at a much higher risk for infection.
“Among the THA patients, patients with hepatitis C had substantially lower preoperative platelet counts and a higher hemoglobin drop,” Pour said. “These patients had a significantly longer hospital stay. Patients with hepatitis C had significantly higher wound drainage and reoperation rate. The rate of dislocation was six-times higher in this group of patients.”
“Overall, patients with hepatitis C had significantly higher complication rates,” he added.
Counsel before proceeding
Pour said the findings point toward a need to counsel hepatitis C patients about the dangers inherent in total joint arthroplasty.
“The outcome of total hip and knee replacement in hepatitis C patients is not as optimal as in the general population,” he said. “It is shown that the hepatitis C virus, even in the absence of cirrhosis, will impair platelet function.”
Pour also acknowledged that the co-existence of comorbidities such as hemophilia and HIV may have also accounted for the higher failure rate of joint replacement in patients with hepatitis C.
- Reference:
Pour AE, Matar W, Jafari SM, et al. Total joint arthroplasty in patients with hepatitis C. Paper #506. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
