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The preoperative management of Hepatitis C may improve the outcome after total knee arthroplasty
- Source :
- The Bone & Joint Journal. :667-674
- Publication Year :
- 2019
- Publisher :
- British Editorial Society of Bone & Joint Surgery, 2019.
-
Abstract
- Aims With an ageing population of patients who are infected with hepatitis C virus (HCV), the demand for total knee arthroplasty (TKA) in this high-risk group continues to grow. It has previously been shown that HCV infection predisposes to poor outcomes following TKA. However, there is little information about the outcome of TKA in patients with HCV who have been treated successfully. The purpose of this study was to compare the outcomes of TKA in untreated HCV patients and those with HCV who have been successfully treated and have a serologically confirmed remission. Patients and Methods A retrospective review of all patients diagnosed with HCV who underwent primary TKA between November 2011 and April 2018 was conducted. HCV patients were divided into two groups: 1) those whose HCV was cured (HCV-C); and 2) those in whom it was untreated (HCV-UT). All variables including demographics, HCV infection characteristics, surgical details, and postoperative medical and surgical outcomes were evaluated. There were 64 patients (70 TKAs) in the HCV-C group and 63 patients (71 TKAs) in the HCV-UT cohort. The mean age at the time of surgery was 63.0 years (sd 7.5; 44 to 79) in the HCV-C group and 61.7 years (sd 6.9; 47 to 88) in the HCV-UT group. Results HCV-UT patients had a significantly longer mean hospital stay (3.4 days vs 2.9 days; p = 0.04), were more likely to be transferred to the intensive care unit (14.1% vs 4.3%; p = 0.04), and were significantly more often discharged to a post-acute care facility (39.4% vs 14.3%; p < 0.01). HCV-UT patients had significantly more postoperative infections (15.5% vs 4.3%; p = 0.03), surgical complications (21.1% vs 7.1%; p = 0.02), and revision TKA (12.7% vs 1.4%; p < 0.01) than HCV-C patients. Conclusion The preoperative treatment of HCV can reduce the risk of complications, including prosthetic joint infection and revision TKA. We recommend that HCV treatment regimens should be integrated into the preoperative optimization protocol for this high-risk group of patients. Cite this article: Bone Joint J 2019;101-B:667–674.
- Subjects :
- Male
Reoperation
Population ageing
medicine.medical_specialty
Hepatitis C virus
Total knee arthroplasty
Comorbidity
medicine.disease_cause
Antiviral Agents
Postoperative Complications
Risk Factors
Internal medicine
Preoperative Care
medicine
Humans
Orthopedics and Sports Medicine
Arthroplasty, Replacement, Knee
Aged
Retrospective Studies
Aged, 80 and over
business.industry
virus diseases
Hepatitis C
Length of Stay
Middle Aged
medicine.disease
digestive system diseases
Treatment Outcome
Female
Surgery
business
Subjects
Details
- ISSN :
- 20494408 and 20494394
- Database :
- OpenAIRE
- Journal :
- The Bone & Joint Journal
- Accession number :
- edsair.doi.dedup.....32b815cb8828014c5146132b0aa0f3af