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Total Joint Arthroplasty in Patients with Hepatitis C

Pour, Aidin Eslam MD; Matar, Wadih Y. MD, MSc, FRCSC; Jafari, S. Mehdi MD; Purtill, James J. MD; Austin, Matthew S. MD; Parvizi, Javad MD, FRCS

Journal of Bone & Joint Surgery - American Volume: 3 August 2011 - Volume 93 - Issue 15 - p 1448–1454
doi: 10.2106/JBJS.J.00219
Scientific Articles

Background: Hepatitis C is present worldwide. Little is known about the outcome of joint arthroplasty in asymptomatic patients with hepatitis C. We evaluated the surgical complications following hip and knee arthroplasty in patients who were seropositive for hepatitis C in a matched study.

Methods: Seventy-one patients with hepatitis C underwent forty total hip arthroplasties and thirty-two total knee arthroplasties from 1995 to 2006. The patients had normal preoperative liver function tests. Patients with human immunodeficiency virus infection, hepatitis B, and hemophilia were excluded. A control group was matched in a 2:1 ratio with the hepatitis-C group for age, body-mass index, sex, year of surgery, and medical comorbidities, including diabetes, rheumatoid arthritis, and immunosuppressive conditions.

Results: In the group of patients with hepatitis C who were managed with total hip arthroplasty, six patients (15%) had wound complications requiring oral antibiotics or wound irrigation and debridement and four hips (10%) had mechanical complications, including implant loosening or dislocation. In the control group, three patients (3.8%) had wound complications requiring oral antibiotics or irrigation and debridement and three patients (3.8%) had mechanical complications, including dislocation, periprosthetic femoral fracture, and implant failure. In the group of patients with hepatitis C who underwent total knee arthroplasty, three patients (9.4%) had mechanical complications, including loosening and periprosthetic fracture requiring revision. In the control group, three patients (4.7%) had wound complications, one (1.6%) had a deep infection requiring two-stage revision, and one (1.6%) underwent revision because of a mechanical problem. The combined hepatitis-C group had significantly longer hospital stays and higher rates of surgical and mechanical complications, reoperation, and revision.

Conclusions: Patients with hepatitis C undergoing joint arthroplasty had a higher rate of surgical complications and a longer hospital stay. The reason for the higher rate of complications in this group of patients is unknown, and further investigation is needed. Patients with hepatitis C should be counseled about the potential for a higher incidence of postoperative complications prior to undergoing joint arthroplasty.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi:

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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