Abstract
Introduction
Interferon (IFN) based treatments for chronic hepatitis C (HCV) have been the standard of care until 2014 when direct antiviral agents (DAA) were introduced. Patients with HCV have had extremely high complication rates after total hip arthroplasty (THA). It is unknown whether HCV is a modifiable risk factor for these complications prior to THA. The purpose of this study was 1) to compare perioperative complication rates between untreated and treated HCV in THA and 2) to compare these rates between patients treated with two different therapies (IFN vs. DAA).
Methods
A multicenter retrospective database query was used to identify patients diagnosed with chronic hepatitis C virus who underwent total hip arthroplasty from 2006–2016. All patients (n=105) identified were included and were divided into two groups: untreated HCV (n=63) and treated (n=42); the treated group were further subdivided into those receiving IFN based therapies (n=16) or DAA therapies (n=26). Comparisons between the treated and untreated groups were made with respect to demographic data, comorbidities, preoperative viral load, MELD score, and all surgical (≤1 yr) and medical (≤90d) complications; a sub-group analysis of the treated patients was also performed. Separate independent t-tests were conducted for dependent variables that were normally distributed, and Mann-Whitney U tests were conducted for variables which were not normally distributed. Categorical variables were compared through the chi-square test of independence. The level of statistical significance was set at p<0.05.
Results
Of the 105 patients, there was a greater number of HIV infected patients in the untreated group and a higher number of smokers in the treated group. Surgical complication rates were higher in the untreated group (25.4% vs. 4.8%; p<0.05) with a PJI rate of 14.3% in the untreated group. There were no differences in medical complications. A sub-group analysis of the different treatments for HCV did not reveal any differences in post-surgical complications.
Discussion and Conclusion
Untreated HCV is traditionally associated with an extremely high rate of postoperative complications following THA. Treatment for HCV prior to THA appears to be associated fewer postoperative complications, primarily PJI. While further investigation is warranted, strong consideration should be given to treating patients for HCV prior to elective THA.
