The 30% rise in the number of joint replacements among patients with hepatitis C was not merely a reflection of a general upswing over the years in these types of operations, says Dr. Mont. Taking into account the number of operations among the general population, the frequency of hepatitis C infection rose from 1.9 per 1,000 total joint arthroplasties in 1998 to 5.9 per 1,000 total joint arthroplasties in 2010.
Previous Studies
Earlier studies that were smaller and conducted at single centers have shown similar findings, Dr. Mont explains. So even though results of the most recent study were somewhat expected, they do help further clarify some concerns facing patients with hepatitis C who have compromised immune systems and may be more susceptible to infection if they undergo surgery, he says.
Orthopedic surgeons should be aware of the increased risks of total joint arthroplasty in patients with hepatitis C & should discuss these risks with potential surgical candidates during a shared decision-making process.
“It’s just defining it a little bit better,” Dr. Mont explains. “We would expect that people who have had hepatitis are going to be more immunocompromised, more subject to vasculitis” and more subject to adverse effects on all of their organ systems, he says.
Future studies are needed to determine whether adopting strict measures to optimize the medical health of a patient infected with hepatitis C could lead to reduced complications from hip or knee arthroplasty, Dr. Mont says.
Conclusions
The authors concluded that hepatitis C infection is an infrequent but increasingly common co-morbidity among patients who undergo total joint arthroplasty.
“Given these findings, orthopaedic surgeons should be aware of the increased risks of total joint arthroplasty in patients with hepatitis C and should discuss these risks with potential surgical candidates during a shared decision-making process,” the authors write in the study.
Insight gained from the study is useful in the counseling of patients with hepatitis C about their increased risks when considering a total joint arthroplasty procedure, according to the authors of a separate commentary that appears in the same journal issue as the study article.2
“An awareness of the need for and benefit of patient education, medical optimization and utilization of a medical or surgical care team approach could help to decrease the complication rate associated with total joint arthroplasty in this population,” write Pooya Javidan, MD, and Richard H. Walker, MD, of the Scripps Clinic in La Jolla, Calif.