Department of Orthopaedics, Massachusetts General Hospital, Boston, MA; Kaplan Joint Center, Department of Orthopedics, Newton-Wellesley Hospital, Newton, MA.
Department of Orthopaedics, Massachusetts General Hospital, Boston, MA.
J Arthroplasty. 2019 Jan;34(1):132-135. doi: 10.1016/j.arth.2018.09.036. Epub 2018 Sep 19.
Patients with chronic hepatitis C (HCV) have had extremely high complication rates after total hip arthroplasty (THA). We sought to compare perioperative complication rates between untreated and treated HCV in THA patients and to compare these rates between patients treated with 2 different therapies (interferon vs direct antiviral agents).
A multicenter retrospective database query was used to identify patients diagnosed with HCV who underwent THA between 2006 and 2016. All patients (n = 105) identified were included and divided into 2 groups: untreated (n = 63) and treated (n = 42) HCV; treated patients were further subdivided into those receiving interferon (n = 16) or direct antiviral agent therapies (n = 26). Comparisons between the treated and untreated groups were made with respect to demographic data, comorbidities, preoperative viral load, Model for End-Stage Liver Disease score, and all surgical and medical complications; a subgroup analysis of the treated patients was also performed. Separate independent t-tests or Mann-Whitney U tests were conducted for continuous variables. Categorical variables were compared using the chi-squared test of independence.
A greater number of untreated patients were human immunodeficiency virus infected (P = .01), while a reduced number of treated patients were either former or current smokers (P = .004). The untreated group had greater surgical complication rates (25.4% vs 4.8%; P = .007), with a higher rate of periprosthetic joint infection (14.3% vs 0%, P = .01). For treated patients, no differences were observed between treatment types for postsurgical complications.
Treatment for HCV prior to THA appears to be associated to fewer postoperative complications, primarily periprosthetic joint infection. Although further investigation is warranted, strong consideration should be given to treating patients for HCV prior to elective THA.
慢性丙型肝炎（HCV）患者在全髋关节置换术后（THA）并发症发生率极高。我们旨在比较未经治疗和治疗后的 HCV 患者在 THA 中的围手术期并发症发生率，并比较两种不同治疗方法（干扰素与直接抗病毒药物）之间的这些发生率。
采用多中心回顾性数据库查询，确定 2006 年至 2016 年间诊断为 HCV 并接受 THA 的患者。对所有确定的患者（n=105）进行分组：未经治疗（n=63）和治疗（n=42）HCV；治疗患者进一步分为接受干扰素（n=16）或直接抗病毒药物治疗（n=26）的患者。对治疗组和未治疗组进行了与人口统计学数据、合并症、术前病毒载量、终末期肝病模型评分以及所有手术和医疗并发症相关的比较；还对治疗患者进行了亚组分析。连续变量采用独立样本 t 检验或 Mann-Whitney U 检验。分类变量采用独立性卡方检验进行比较。
未治疗组中更多的患者感染了人类免疫缺陷病毒（P=.01），而接受治疗组中以前或现在吸烟的患者数量较少（P=.004）。未治疗组的手术并发症发生率更高（25.4% vs 4.8%；P=.007），假体周围关节感染发生率更高（14.3% vs 0%，P=.01）。对于治疗患者，两种治疗类型之间在术后并发症方面无差异。
在 THA 之前治疗 HCV 似乎与术后并发症减少有关，主要是假体周围关节感染。尽管需要进一步研究，但在选择性 THA 之前，应强烈考虑治疗 HCV 患者。
