Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load
Background: Preoperative treatment recommendations and optimal time to perform total joint arthroplasty (TJA) in patients with hepatitis C virus after treatment completion for achieving best outcomes have not been elucidated. We aim to determine (1) if undetectable viral load (UVL) prior to TJA lead...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344122001431 |
| _version_ | 1797996658068291584 |
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| author | Kyle H. Cichos, BS Eric Jordan, BS Kian Niknam, BS Antonia F. Chen, MD, MBA Erik N. Hansen, MD Gerald McGwin, Jr, PhD Elie S. Ghanem, MD |
| author_facet | Kyle H. Cichos, BS Eric Jordan, BS Kian Niknam, BS Antonia F. Chen, MD, MBA Erik N. Hansen, MD Gerald McGwin, Jr, PhD Elie S. Ghanem, MD |
| author_sort | Kyle H. Cichos, BS |
| collection | DOAJ |
| description | Background: Preoperative treatment recommendations and optimal time to perform total joint arthroplasty (TJA) in patients with hepatitis C virus after treatment completion for achieving best outcomes have not been elucidated. We aim to determine (1) if undetectable viral load (UVL) prior to TJA leads to decreased postoperative complication rates, specifically periprosthetic joint infection (PJI), and (2) if delaying TJA after treatment completion has benefit in decreasing PJI. Methods: A retrospective review of all hepatitis C virus patients undergoing TJA at 3 academic tertiary care centers was conducted. A total of 270 TJAs performed from 2005 to 2019 were included, 125 with positive viral load at the time of surgery. The duration from completion of treatment regimen to TJA was recorded for the UVL cohort. The primary study outcome was PJI at 1-year follow-up. Secondary outcomes included in-hospital complications, mechanical revision TJA rates, and optimal time to TJA upon completion of treatment. Results: Patients with positive viral load at the time of TJA had longer length of stay (3.9 vs 2.9 days, P < .0001) and a higher PJI rate at 1 year postoperatively (9% vs 2%, P = .02) than UVL patients. There was no difference of in-hospital complications or revision rates for mechanical etiologies. Delaying TJA after achieving a sustained virologic response did not impact PJI rates. Conclusions: Sustained UVL prior to TJA is critical to minimize PJI irrespective of the treatment regimen utilized. Surgery can be performed with lower complication rates any time after achieving sustained virologic response. Level of Evidence: Level III, prognostic retrospective cohort study. |
| first_indexed | 2024-04-11T10:20:50Z |
| format | Article |
| id | doaj.art-c8567c112b73425b95187cc7528fdbb8 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-11T10:20:50Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-c8567c112b73425b95187cc7528fdbb82022-12-22T04:29:46ZengElsevierArthroplasty Today2352-34412022-10-0117107113Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral LoadKyle H. Cichos, BS0Eric Jordan, BS1Kian Niknam, BS2Antonia F. Chen, MD, MBA3Erik N. Hansen, MD4Gerald McGwin, Jr, PhD5Elie S. Ghanem, MD6Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USADepartment of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USADepartment of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Corresponding author. Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Suite 207, Birmingham, AL 35205, USA. Tel.: +1 205 930 8543.Background: Preoperative treatment recommendations and optimal time to perform total joint arthroplasty (TJA) in patients with hepatitis C virus after treatment completion for achieving best outcomes have not been elucidated. We aim to determine (1) if undetectable viral load (UVL) prior to TJA leads to decreased postoperative complication rates, specifically periprosthetic joint infection (PJI), and (2) if delaying TJA after treatment completion has benefit in decreasing PJI. Methods: A retrospective review of all hepatitis C virus patients undergoing TJA at 3 academic tertiary care centers was conducted. A total of 270 TJAs performed from 2005 to 2019 were included, 125 with positive viral load at the time of surgery. The duration from completion of treatment regimen to TJA was recorded for the UVL cohort. The primary study outcome was PJI at 1-year follow-up. Secondary outcomes included in-hospital complications, mechanical revision TJA rates, and optimal time to TJA upon completion of treatment. Results: Patients with positive viral load at the time of TJA had longer length of stay (3.9 vs 2.9 days, P < .0001) and a higher PJI rate at 1 year postoperatively (9% vs 2%, P = .02) than UVL patients. There was no difference of in-hospital complications or revision rates for mechanical etiologies. Delaying TJA after achieving a sustained virologic response did not impact PJI rates. Conclusions: Sustained UVL prior to TJA is critical to minimize PJI irrespective of the treatment regimen utilized. Surgery can be performed with lower complication rates any time after achieving sustained virologic response. Level of Evidence: Level III, prognostic retrospective cohort study.http://www.sciencedirect.com/science/article/pii/S2352344122001431Hepatitis COutcomesTotal joint arthroplastyPeriprosthetic joint infectionViral load levelTreatment |
| spellingShingle | Kyle H. Cichos, BS Eric Jordan, BS Kian Niknam, BS Antonia F. Chen, MD, MBA Erik N. Hansen, MD Gerald McGwin, Jr, PhD Elie S. Ghanem, MD Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load Arthroplasty Today Hepatitis C Outcomes Total joint arthroplasty Periprosthetic joint infection Viral load level Treatment |
| title | Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load |
| title_full | Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load |
| title_fullStr | Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load |
| title_full_unstemmed | Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load |
| title_short | Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load |
| title_sort | total joint arthroplasty should not be delayed in hepatitis c patients after successful treatment achieving a sustained viral load |
| topic | Hepatitis C Outcomes Total joint arthroplasty Periprosthetic joint infection Viral load level Treatment |
| url | http://www.sciencedirect.com/science/article/pii/S2352344122001431 |
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