Preoperative HCV treatment lowers odds of prosthetic joint infection

  • Bendich I & al.
  • J Arthroplasty
  • 9 Mar 2019

  • International Clinical Digest
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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.