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Hepatitis C Is Associated With Higher Short-Term Complication Rates After Initial Aseptic and Septic Revision Total
Bailey J Ross1, Matthew W Cole2, Austin J Ross2
1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Hepatitis C virus (HCV) patients undergoing revision total hip arthroplasty (rTHA) show increased complication rates, including kidney injury and infection-related re-revisions. These findings highlight the need for careful management in this growing patient population.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- Outcomes of revision total hip arthroplasty (rTHA) in patients with hepatitis C virus (HCV) remain unclear.
- Understanding these outcomes is crucial given the increasing prevalence of HCV in the population undergoing rTHA.
Purpose of the Study:
- To analyze trends in rTHA utilization among patients with HCV.
- To compare postoperative complication rates in HCV patients undergoing rTHA versus a matched control group.
Main Methods:
- Retrospective analysis of a national database for rTHA procedures.
- Matching 1,746 HCV patients with 5,238 non-HCV patients based on age, gender, and comorbidities.
- Statistical analysis of utilization trends (2010-2019) and complication rates using Cochran-Armitage tests and multivariable logistic regressions.
Main Results:
- A significant increase in the proportion of rTHA performed in HCV patients from 2010 to 2019.
- HCV patients had higher rates of acute kidney injury (OR 1.50), transfusions (OR 1.38), and re-revisions for prosthetic joint infection (OR 1.73).
- Subgroup analyses revealed higher rates of re-revision for infection after aseptic rTHA (OR 1.82) and periprosthetic fracture after septic rTHA (OR 2.77) in the HCV cohort.
Conclusions:
- Patients with HCV experience significantly higher complication rates following rTHA, similar to primary total hip arthroplasty.
- The increasing utilization of rTHA in HCV patients suggests they will represent a larger proportion of future procedures.
- These findings underscore the importance of tailored perioperative management for HCV patients undergoing rTHA.
Background:
It is unclear if hepatitis C virus (HCV) negatively impacts outcomes of revision total hip arthroplasty (rTHA). The purpose of this study is to trend recent rTHA utilization in patients who have HCV and compare postoperative complication rates versus a matched cohort.
Methods:
All patients who underwent rTHA were retrospectively identified in a national database. Patients who had HCV (n = 1,746) were matched 1:3 with a matching group (n = 5,238) for age, gender, and several comorbidities. Cochran-Armitage tests were used to analyze trends in the annual proportion of rTHA performed in patients who had HCV from 2010 to 2019. Rates of 90-day medical and prosthesis-related complications within 2 years postoperatively were compared with multivariable logistic regressions.
Results:
The annual proportion of rTHA performed in patients who had HCV significantly increased from 2010 to 2019 (P < .001). Patients who had HCV exhibited significantly higher rates of acute kidney injuries (7.6% versus 4.4%; odds ratio [OR] 1.50), transfusions (20.6% versus 14.6%; OR 1.38), and re-revisions for prosthetic joint infection (10.9% versus 6.5%; OR 1.73). In subgroup analyses, rates of re-revision for prosthetic joint infection after initial aseptic rTHA (7.1% versus 3.8%; OR 1.82) and periprosthetic fracture after initial septic rTHA (4.5% versus 1.6%; OR 2.77) were significantly higher in the HCV cohort.
Conclusion:
Similar to primary THA, patients who have HCV exhibit significantly increased complication rates after rTHA. With growing utilization in recent years, these data suggest that this population will comprise an increasingly larger proportion of rTHA procedures performed in the coming years.
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