Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, The People's Republic of China.
J Arthroplasty. 2022 Sep;37(9):1870-1878. doi: 10.1016/j.arth.2022.04.027. Epub 2022 Apr 26.
Recently, preoperative antiviral therapies for hepatitis C virus (HCV) have become available for total joint arthroplasty (TJA) patients. The objective of this meta-analysis is to investigate the impact of anti-HCV treatment on the incidence of postoperative complications after primary TJAs.
We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library databases for relevant studies from inception to March 5, 2022. The pooled odds ratios with 95% CI of the risk of postoperative complications were calculated using the random effects model. Subgroup analyses were conducted on the basis of surgery type, antiviral regimes, and duration of follow-up.
Eight retrospective cohort studies fulfilled the inclusion and exclusion criteria, involving 9,703 subjects. Overall, antiviral therapy for HCV was associated with a reduced risk of all-type complications and surgical complications. Moreover, we found that HCV-infected patients without treatment had substantially higher rates of periprosthetic joint infection at any surgery type and follow-up time point. There was a tendency for favoring a lower pooled revision/reoperation rate and mechanical complication rate in treated patients compared with untreated patients, but the differences failed to reach statistical significance. When limiting analysis to patients receiving preoperative direct acting antiviral-based therapy, untreated patients still had a higher surgical complication rate and joint infection rate.
This meta-analysis demonstrated that antiviral therapy for HCV appears to be associated with a reduced risk of surgical complications in TJA patients, particularly periprosthetic joint infection. Thus, direct-acting antiviral therapy could be recommended for patients diagnosed with HCV.
最近，用于治疗丙型肝炎病毒（HCV）的术前抗病毒疗法已可用于全膝关节置换术（TJA）患者。本荟萃分析的目的是研究抗 HCV 治疗对初次 TJA 后术后并发症发生率的影响。
我们从建库到 2022 年 3 月 5 日在 PubMed、EMBASE、Scopus、Web of Science 和 Cochrane Library 数据库中检索相关研究。使用随机效应模型计算术后并发症风险的合并优势比（OR）及其 95%置信区间（CI）。根据手术类型、抗病毒方案和随访时间进行亚组分析。
八项回顾性队列研究符合纳入和排除标准，共涉及 9703 例患者。总体而言，HCV 抗病毒治疗与降低所有类型并发症和手术相关并发症的风险有关。此外，我们发现未治疗的 HCV 感染患者在任何手术类型和随访时间点都有更高的假体周围关节感染率。与未治疗的患者相比，接受治疗的患者的总体翻修/再手术率和机械并发症率较低，但差异无统计学意义。当将分析限制在接受术前直接作用抗病毒治疗的患者时，未治疗的患者仍有更高的手术并发症发生率和关节感染率。
本荟萃分析表明，HCV 的抗病毒治疗似乎与 TJA 患者手术相关并发症的风险降低相关，尤其是假体周围关节感染。因此，对于诊断为 HCV 的患者，直接作用抗病毒治疗可能是推荐的。
