Total Joint Arthroplasty in the Hepatitis C Patient

Approximately 3.2 million Americans have hepatitis C, according to the Viral Hepatitis Coalition, and every year, roughly 17,000 more are newly diagnosed. Fortunately, the Food and Drug Administration has approved a number of treatments that are more effective and tolerable than previous options. With people with hepatitis C living longer and healthier lives, they are more apt to need or want total joint arthroplasty. What does current research tell surgeons?

Researchers from four leading surgical centers investigated the hypothesis that hepatitis C infection increases risk of adverse outcomes after lower-extremity total joint arthroplasty. Because most data is limited and conflicting, they used the Nationwide Inpatient Sample database to identify patients who underwent a total hip or knee arthroplasty in the United States from 1998 to 2010. They employed controls in a three-to-one ratio to patients with hepatitis-C infection.

This database included information on 1,700,400 total joint arthroplasties during the study period. A small number of patients—8,044 patients or just 0.47%)—had a documented hepatitis-C infection. The frequency of hepatitis-C infection increased from the study’s start (1.9 per 1000 in 1998) to its end in 2010 (5.9 per 1000), a trend that is expected to continue.

Compared to controls, patients with hepatitis C were significantly more likely to experience any complication. Their risk was 30% higher than control’s risk.

Patients with hepatitis were 15% more likely to have a medical complication and 78% more likely to have a surgical complication than matched controls. The researchers suggest that the latter risk may be associated with hepatitis C’s multi-organ complications, including hepatitis, membranoproliferative glomerulonephritis, and thrombocytopenia.

A diagnosis of hepatitis was associated with a mean length of stay 14% longer than others.

The researchers recommend that orthopedic surgeons discuss the potential for increased risks with hepatitis C patients, and share the decision-making process with the patient. They note that more information is needed about a specific population—patients who have been treated and now have resolved hepatitis C. This article appears in the January 2016 issue of Journal of Bone and Joint Surgery.