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Perioperative Management of Hepatitis C in Patients Undergoing Total Joint Arthroplasty

Phillip E Ross1, Joseph R Young, Casey M O'Connor

  • 1Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York.

JBJS Reviews
|November 10, 2021
PubMed

Insights

Treating hepatitis C virus (HCV) before total joint arthroplasty (TJA) is recommended for patients with HCV. Preoperative HCV treatment improves outcomes and reduces long-term healthcare costs, despite initial higher expenses.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Hepatology

Background:

  • Hepatitis C virus (HCV) infection is an increasing concern for total joint arthroplasty (TJA) candidates.
  • HCV is a significant risk factor for periprosthetic joint infections, which have poor patient outcomes.
  • Traditional HCV treatments (interferon and ribavirin) had limitations due to adverse events and inconsistent efficacy.

Purpose of the Study:

  • To recommend preoperative treatment for HCV in TJA candidates.
  • To highlight the challenges and benefits of managing HCV in this patient population.
  • To emphasize the long-term cost-effectiveness of HCV treatment before elective TJA.

Main Methods:

  • Review of current literature on HCV management in TJA candidates.
  • Analysis of treatment outcomes and associated costs.
  • Discussion of multidisciplinary care approaches for optimizing patient care.

Main Results:

  • Direct-acting antivirals (DAAs) offer improved efficacy and tolerability over older HCV therapies.
  • Barriers to DAA treatment include financial burdens and inconsistent insurance coverage.
  • Multidisciplinary care is essential for addressing the complex medical, economic, and psychosocial needs of TJA candidates with HCV.

Conclusions:

  • Preoperative HCV management is crucial for improving TJA outcomes and reducing infection risk.
  • While upfront costs for HCV treatment are higher, it leads to reduced long-term patient morbidity and healthcare expenditures.
  • Optimizing HCV treatment in TJA candidates requires a comprehensive, multidisciplinary approach.
Abstract

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