Higher complication rates after TJA among patients not treated for hepatitis C

Ilya Bendich

DALLAS — The hepatitis C virus may be a treatable risk factor for patients undergoing total joint arthroplasty, based on results of a study conducted in a U.S. veteran population.

Among 42,268 patients who underwent TJA at Veterans Administration hospitals between 2014 and 2018, “6% of those patients had hepatitis C and 17% of the patients with hepatitis C were treated preoperatively with one of the oral agents” that are among the newer direct-acting antivirals, Ilya Bendich, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting.

Bendich and his colleagues found that among all the veterans they identified with hepatitis C, 28,125 patients underwent total knee arthroplasty and 14,143 patients underwent total hip arthroplasty. Patients with hepatitis C tended to be younger and had more comorbidities, he said.

Regarding 90-day surgical complications, “what we found were elevated implant infection rates and mechanical complications among patients with untreated hepatitis C,” Bendich said, noting investigators found a 2.5% and 0.7% 90-day implant infection rate among untreated and preoperatively treated patients, respectively.

Multivariate regression analysis results suggested that patients without hepatitis C had a lower likelihood of developing an infection at 90-days postoperatively, according to Bendich.

“Our 1-year results mimic our 90-day results,” he said.

The study abstract detailed a 10% rate of medical complications and a 5% rate of surgical complications at 1 year for patients who underwent THA with hepatitis C that was not treated. By comparison, patients who were treated for the hepatitis C virus had lower rates of these complications at 0.8% and 0%, respectively.

Despite the various limits of the investigation that Bendich discussed, he said, “This is the first study to associate preoperative hepatitis C treatment with postoperative complications. Patients without hepatitis C have the lowest risk of infection, whereas those with untreated hepatitis C have the highest risk. So, hepatitis C may be a modifiable risk factor, and we show that preoperative treatments are associated with lower short-term prosthetic infection rates,” Bendich said. – by Susan M. Rapp

Reference:

Bendich I, et al. Paper 32. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.

Disclosure: Bendich reports the study was funded by institutional grants.