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Association of hepatitis B infection with high-risk complications in total joint arthroplasty

Jin Wang¹, Guanglei Zhao¹, Jie Chen¹

¹Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.

BMC Musculoskeletal Disorders

|April 12, 2019

Insights

Hepatitis B virus (HBV) infection significantly increases the risk of complications following total joint arthroplasty (TJA). Patients with HBV infection had a higher incidence of both surgical and medical issues after TJA surgery.

Area of Science:

Orthopedic Surgery
Infectious Diseases
Public Health

Background:

An increasing number of patients with Hepatitis B virus (HBV) infection in China are undergoing total joint arthroplasty (TJA).
Limited attention has been given to the specific risks and outcomes for this patient population undergoing TJA.
This study addresses the need to assess the impact of HBV infection on TJA prognosis.

Purpose of the Study:

To evaluate the effect of Hepatitis B virus (HBV) infection on the prognosis of patients undergoing total joint arthroplasty (TJA).
To determine if HBV infection is a significant risk factor for postoperative complications in TJA patients.
To compare complication rates between HBV-infected and non-infected TJA cohorts.

Main Methods:

Retrospective review of elective primary hip and knee arthroplasties performed between 2013 and 2016.
Inclusion of 196 patients: 49 with HBV infection (case cohort) and 147 without (control cohort).
Matching of the non-hepatitis B cohort to the case cohort to identify risk factors for postoperative complications.

Main Results:

Patients with HBV infection had a significantly higher overall complication rate (10.2%) compared to those without (4.7%).
HBV infection increased the risk of surgical complications by 18% and medical complications by 31%.
Elevated C-reactive protein (CRP) levels were observed in the HBV-infected group compared to the non-infected group.

Conclusions:

This is the first study to investigate perioperative complications of hepatitis B in Chinese TJA patients.
HBV infection is associated with increased risks of both surgical and general medical complications after TJA.
Enhanced medical care and attention are recommended for TJA patients with HBV infection due to the high prevalence in China.

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Abstract

Background:

An increasing number of patients with hepatitis B virus (HBV) infection are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations and the purpose of this study is to assess the effect of HBV infection on the prognosis TJAs.

Methods:

We retrospectively reviewed patients who underwent elective primary hip and knee arthroplasties in Shanghai Huashan Hospital from 2013 to 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 196 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects.

Results:

Among all the patients with TJAs, 5.5% of patients were infected with HBV for the first time. The incidence rate of complications in patients after arthroplasty with hepatitis B infection was significantly higher than that in patients without hepatitis B (10.2% compared to 4.7%, P < 0.01). Surgical related complications (6.1% compared to 3.4%) and general medical complications (4.1% compared to 1.3%) were higher than those in non-B hepatitis group. Compared with non-B hepatitis group, the overall risk of hepatitis B infection increased by 25% (95% CI, 1.04-1.46; p < 0.01). Similar results were obtained for medical and surgical complications. HBV infection presented a 31% increased risk (95% CI, 1.02-1.62; p < 0.01) for medical complication and an 18% increased risk (95% CI, 1.10-1.26; p < 0.01) for surgical complication. No statistical difference was found between the surgical methods and sex. However, a significant difference of C-reactive protein (CRP) level was found between HBV infection group and the matched non-infected group (P < 0.01).

Conclusion:

This is the first study to investigate the risk of perioperative complications of hepatitis B in Chinese TJAs patients. In consideration of the large population of HBV infection in China, more attention and medical care should be provided to patients with HBV infection who need to undergo TJA operation.

Keywords:

Complication Hepatitis B infection Risk factor Total joint arthroplasty

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