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Updated: Mar 17, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Is Hepatitis C Infection Associated With a Higher Risk of Complications After Total Shoulder Arthroplasty?
Jourdan M Cancienne1, Ian J Dempsey1, Russell E Holzgrefe1
1Department of Orthopaedic Surgery, University of Virginia, PO Box 800136, Charlottesville, VA, 22908, USA.
Insights
Patients with hepatitis C face higher risks for complications after total shoulder arthroplasty (TSA), including infection, dislocation, and revision surgery. These findings highlight the need for careful patient selection and management in this population.
Area of Science:
- Orthopedic Surgery
- Hepatology
- Public Health
Background:
- Hepatitis C affects millions, with known risks in lower-extremity surgery.
- No studies have assessed these risks specifically for total shoulder arthroplasty (TSA).
Purpose of the Study:
- To determine if patients with hepatitis C have increased complication risks after TSA.
- To identify specific complications more likely in this patient group.
Main Methods:
- Retrospective analysis of the PearlDiver database (2005-2012).
- 1466 patients with hepatitis C undergoing TSA compared to 21,502 matched controls.
- Exclusion of patients with hepatitis B or HIV; matching for age, sex, obesity, and diabetes.
Main Results:
- Hepatitis C patients showed higher odds of infection (OR 1.7-2.1), revision TSA (OR 1.5-1.6), dislocation (OR 1.6), and fracture (OR 1.8) within one year.
- Increased risk of systemic complications (OR 1.3) and blood transfusion (OR 1.7) within three months.
- All results were statistically significant (p < 0.05).
Conclusions:
- Hepatitis C is linked to increased risks for infection, dislocation, fracture, revision TSA, systemic issues, and transfusion after shoulder arthroplasty.
- The exact causes may involve case complexity and socioeconomic factors beyond the virus itself.
Background:
Despite recent advances in the treatment of hepatitis C, it is estimated that nearly 4 million Americans have a chronic form of the disease. Although research in lower-extremity arthroplasty suggests patients with hepatitis C are at risk for increased complications, including postoperative bleeding, acute postoperative infection, and general medical complications, no similar studies have investigated this question in patients undergoing total shoulder arthroplasty (TSA).
Questions/Purposes:
We asked whether there is an increased risk of postoperative complications after TSA among patients who have hepatitis C, and if so, what complications in particular seem more likely to occur in this population?
Methods:
Patients who underwent TSA, including anatomic or reverse TSA, were identified in the PearlDiver database using ICD-9 procedure codes. This is a for-fee insurance patient-records database that contains more than 100 million individual patient records from 2005 to 2012. The Medicare data in the database are the complete 100% Medicare Standard Analytical File indexed to allow for patient tracking with time. Patients with hepatitis C who underwent shoulder arthroplasty then were identified using ICD-9 codes. Patients with hepatitis B coinfection or HIV were excluded. A control cohort of patients without hepatitis C who underwent TSA was created and matched to the study cohort based on age, sex, obesity, and diabetes mellitus. A total of 1466 patients with hepatitis C and 21,502 control patients were included. The two cohorts were statistically similar in terms of sex (53% females in study and control groups), age (nearly ½ of each cohort younger than 65 years), obesity (approximately 17% of each cohort were obese), diabetes (approximately 40% of each cohort had diabetes), and followup of each cohort occurred throughout the length of the database from 2005 to 2012. Postoperative complications were assessed using ICD-9 and Current Procedural Terminology codes and compared between cohorts.
Results:
Patients with hepatitis C, when compared with matched control subjects, had greater odds of infection within 3 months (odds ratio [OR], 1.7; 95% CI, 1.1-2.6; p = 0.015), 6 months (OR, 1.7; CI, 1.3-2.4; p = 0.001), and 1 year (OR, 2.1; CI, 1.7-2.7; p < 0.001); revision TSA within 1 year (OR, 1.5; CI, 1.1-2.9; p = 0.008) and 2 years (OR, 1.6; CI, 1.2-2.0; p = 0.001), dislocation within 1 year (OR, 1.6; CI, 1.2-2.2; p < 0.001); postoperative fracture within 1 year (OR, 1.8; CI, 1.2-2.6; p = 0.002); systemic or medical complications within 3 months (OR, 1.3; CI, 1.0-1.6; p = 0.022); and blood transfusion within 3 months (OR, 1.7; CI, 1.4-1.9; p < 0.001).
Conclusions:
Hepatitis C is associated with an increased risk for complications after TSA, including infection, dislocation, fracture, revision TSA, systemic complications, and blood transfusion compared with matched control subjects. Although this study is able to identify increased odds of complications in patients with hepatitis C, the mechanism by which these occur is likely not solely related to the virus, and is more likely related to a higher degree of case complexity in addition to other postoperative socioeconomic factors.
Level Of Evidence:
Level III, therapeutic study.
