Takeaway
- Preoperative HCV treatment is associated with lower odds of infection after total joint arthroplasty.
Why this matters
- Findings support HCV as a modifiable risk factor in the era of direct-acting antivirals (DAAs).
Study design
- Data for 42,268 patients who had total arthroplasty of the hip (THA; 33.5%) or knee (TKA; 66.5%) at Veterans Affairs hospitals, 2014-2018.
- Of 2557 (6.05%) HCV-infected patients, 17.3% received DAAs preoperatively.
- Funding: James O. Johnston Resident Grant, other institutional grants.
Key results
- Implant infection rates were lower with DAA treatment vs nontreatment (P<.001) at:
- 90 days postoperative: 0.7% vs 2.5% (noninfected, 1.1%).
- 1 year postoperative: 1.4% vs 3.2% (noninfected, 1.6%).
- Benefits of DAA treatment were apparent in:
- THA: 0.5% vs 1.8% at 90 days; 0.5% vs 2.6% at 1 year.
- TKA: 0.8% vs 2.8%, 90 days; 1.9% vs 3.6%, 1 year.
- DAA-treated patients had lower mechanical complication rates at:
- 90 days: 0.0% vs 0.8% (P<.001); and
- 1 year: 0.0% vs 0.8% (P=.019).
- In multivariate analysis, HCV nontreatment was associated with higher HCV infection rates at 90 days (OR, 3.30; P=.045).
- Association was not statistically significant at 1 year (P=.07).
Limitations
- Reliance on diagnostic codes.
- Small sample size.
- Eradication, cirrhosis not captured.
- Retrospective, observational design.
References
References