Boston University School of Medicine, Boston, MA.
Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
J Arthroplasty. 2021 May;36(5):1551-1555. doi: 10.1016/j.arth.2020.12.025. Epub 2021 Jan 8.
Patients with hepatitis C virus (HCV) have an increased risk of complications after total joint arthroplasty (TJA). There is a limited but growing body of evidence on the benefit of preoperative antiviral treatment to reduce complications after TJA. What has not been well established is the effect of preoperative antiviral treatment among those with advanced disease as indicated by hepatic fibrosis.
In total, 270 patients at 2 urban medical centers were reviewed for patient demographics, comorbidities, HCV treatment, hepatic fibrosis status, surgical information, and postoperative complications. Patients were divided into 2 groups based on their antiviral treatment status prior to TJA: Treated (n = 129) and Untreated (n = 141). Pearson's chi-squared test, Student's t-test, and multivariate logistic regressions were used to analyze complications between groups.
Patients in the Treated group had significantly fewer all-type complications (4.7% vs 14.9%, P = .007), infections (2.3% vs 12.1%, P = .002), and reoperations (0.8% vs 9.9%, P = .001) compared to the Untreated group. After controlling for hepatic fibrosis, we found that Treated patients still had significantly lower odds of experiencing all-type complications (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.10-0.88; P = .028), infection (OR 0.19, 95% CI 0.04-0.87; P = .033), and reoperation (OR 0.11, 95% CI 0.01-0.90; P = .039) following TJA.
HCV antiviral treatment reduces postoperative complications after primary TJA, even among those who have progressed to hepatic fibrosis. Surgeons can use this information in shared decision making prior to TJA to counsel patients about the benefits of preoperative antiviral treatment even in the presence of hepatic fibrosis.
丙型肝炎病毒（HCV）患者在接受全关节置换术（TJA）后发生并发症的风险增加。有越来越多的证据表明，术前抗病毒治疗可降低 TJA 后并发症的发生风险，但尚未明确的是，对于那些已经进展到肝纤维化的晚期疾病患者，术前抗病毒治疗的效果如何。
共对 2 家城市医疗机构的 270 例患者进行了患者人口统计学、合并症、HCV 治疗、肝纤维化状态、手术信息和术后并发症的回顾性分析。根据 TJA 前的抗病毒治疗情况，将患者分为两组：治疗组（n=129）和未治疗组（n=141）。采用 Pearson 卡方检验、Student t 检验和多变量逻辑回归分析两组间的并发症。
与未治疗组相比，治疗组的所有类型并发症（4.7% vs 14.9%，P=0.007）、感染（2.3% vs 12.1%，P=0.002）和再次手术（0.8% vs 9.9%，P=0.001）的发生率明显更低。在控制了肝纤维化后，我们发现治疗组患者发生所有类型并发症（优势比 [OR] 0.30，95%置信区间 [CI] 0.10-0.88；P=0.028）、感染（OR 0.19，95%CI 0.04-0.87；P=0.033）和再次手术（OR 0.11，95%CI 0.01-0.90；P=0.039）的可能性明显更低。
即使在存在肝纤维化的情况下，HCV 抗病毒治疗也可降低初次 TJA 后的术后并发症发生率。外科医生可以在 TJA 前的共同决策中利用这些信息，告知患者术前抗病毒治疗的益处，即使患者存在肝纤维化。
