Cichos Kyle H, Jordan Eric, Niknam Kian, Chen Antonia F, Hansen Erik N, McGwin Gerald, Ghanem Elie S
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Arthroplast Today. 2022 Aug 29;17:107-113. doi: 10.1016/j.artd.2022.06.014. eCollection 2022 Oct.
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.
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.
Patients with positive viral load at the time of TJA had longer length of stay (3.9 vs 2.9 days, < .0001) and a higher PJI rate at 1 year postoperatively (9% vs 2%, = .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.
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 III, prognostic retrospective cohort study.
对于丙型肝炎病毒患者，治疗完成后进行全关节置换术（TJA）以获得最佳疗效的术前治疗建议和最佳手术时间尚未阐明。我们旨在确定：（1）TJA术前病毒载量不可测（UVL）是否会导致术后并发症发生率降低，特别是假体周围关节感染（PJI）；（2）治疗完成后延迟TJA是否有利于降低PJI发生率。
对3家学术性三级医疗中心接受TJA的所有丙型肝炎病毒患者进行回顾性研究。纳入2005年至2019年期间进行的270例TJA，其中125例在手术时病毒载量为阳性。记录UVL队列从治疗方案完成到TJA的时间。主要研究结局是1年随访时的PJI。次要结局包括住院并发症、机械性翻修TJA率以及治疗完成后进行TJA的最佳时间。
TJA时病毒载量为阳性的患者住院时间更长（3.9天对2.9天，<0.0001），术后1年PJI发生率更高（9%对2%，P = 0.02），高于UVL患者。住院并发症或机械性病因的翻修率无差异。在获得持续病毒学应答后延迟TJA对PJI发生率无影响。
无论采用何种治疗方案，TJA术前持续UVL对于将PJI降至最低至关重要。在获得持续病毒学应答后的任何时间均可进行手术，并发症发生率较低。
III级，预后性回顾性队列研究。
