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Treatment for Chronic Hepatitis C Prior to Total Hip Arthroplasty Reduces Periprosthetic Joint Infection

Key findings

  • In a multicenter retrospective study, treatment of chronic HCV infection prior to total hip arthroplasty (THA) reduced the risk of periprosthetic joint infection and other surgical complications
  • The choice of treatment for HCV infection (interferon vs direct antiviral agent) did not influence surgical or medical outcomes
  • All candidates for elective THA who have chronic HCV infection should be considered for treatment prior to surgery

Among patients undergoing total hip arthroplasty (THA), the incidence of devastating periprosthetic joint infection and other complications is unacceptably high for those chronically infected with the hepatitis C virus (HCV). Until recently, though, it was unknown whether HCV infection is a reversible risk factor for perioperative complications.

Now, orthopedic surgeons at Massachusetts General Hospital and elsewhere have published the first evidence that treatment of HCV infection before THA improves surgical outcomes. Hany S. Bedair, MD, orthopedic surgeon at the Center for Hip & Knee Replacement, and colleagues report their findings in the The Journal of Arthroplasty.

At three hospitals, the researchers reviewed the records of 105 patients who had chronic HCV infection who underwent unilateral THA between January 2006 and December 2016. Forty-two were treated before THA and 63 were untreated.

The overall rate of surgical complications was significantly higher in the untreated group than in the treated group (25% vs. 5%, P=.007), the researchers found. The same was true when just periprosthetic joint infections were considered (14% vs. 0, P=.01).

Notably, the research team adds, these differences were observed even though the two groups were similar with regard to preoperative severity of hepatic disease, as evidenced by Model for End-Stage Liver Disease scores (the basis of prioritizing patients for liver transplantation) and presence of hepatic fibrosis.

More patients in the untreated group than in the treated group had medical complications during the first 90 days postoperatively (14% vs. 9.5%), but this difference was not statistically significant.

The researchers compared the 16 patients in the treated group who received interferon with the 26 patients who received direct antiviral agents. There were no significant differences in surgical or medical complications between these two subgroups.

It is clear, the research team concludes, that clinicians should strongly consider treating patients for HCV infection prior to elective THA. The uncertainty is whether individual patients will be able to access direct antiviral agents. They are exceptionally effective, but they can cost $60,000 or more for a course of treatment.

However, the authors note, that expense pales in comparison with the financial and personal burden of treating periprosthetic joint infection, estimated to be $300,000 to $500,000 per case.

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