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Fibrosis in hepatitis C patients predicts complications after elective total joint arthroplasty

Fabio Orozco1, Zachary D Post, Omkar Baxi

  • 1Jefferson Medical College, Dept. of Orthopaedic Surgery, Philadelphia, Pennsylvania.

The Journal of Arthroplasty
|May 8, 2013
PubMed

Insights

Hepatitis C patients undergoing hip or knee replacement generally have good outcomes. However, those with liver fibrosis face higher risks of infection and complications after knee surgery.

Area of Science:

  • Orthopedic Surgery
  • Hepatology
  • Infectious Disease

Background:

  • The impact of Hepatitis C virus (HCV) infection on the outcomes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) remains unclear.
  • Understanding these effects is crucial for optimizing patient care and surgical planning in this population.

Purpose of the Study:

  • To evaluate the outcomes of primary THA and TKA in patients with Hepatitis C.
  • To investigate whether fibrosis or thrombocytopenia in Hepatitis C patients influences post-arthroplasty complication rates compared to matched controls.

Main Methods:

  • Retrospective review of 72 patients with Hepatitis C who underwent 77 primary THA or TKA procedures.
  • Patients were stratified based on the presence of liver fibrosis and thrombocytopenia.
  • Outcomes were compared to a matched control group without Hepatitis C.

Main Results:

  • Overall outcomes for Hepatitis C patients and controls were similar.
  • Hepatitis C patients with liver fibrosis undergoing TKA showed a significantly greater average hemoglobin drop (4.9 vs. 3.8, P=0.023).
  • These fibrotic patients also had higher rates of deep infection (21% vs. 0%, P=0.047) and cellulitis (21% vs. 0%, P=0.047) after TKA. Thrombocytopenia showed a trend towards increased infections.

Conclusions:

  • Hepatitis C patients without significant fibrosis do not appear to have an increased risk of complications after joint arthroplasty.
  • The presence of liver fibrosis in Hepatitis C patients may predict poorer outcomes, specifically higher infection rates and complications, after TKA.
  • Further evaluation of fibrosis is recommended to identify Hepatitis C patients at higher risk for adverse joint arthroplasty outcomes.

Keywords:
Outcomescomplicationsfibrosishepatitis Ctotal joint arthroplasty

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