Preoperative Antiviral Treatment for Hepatitis C Virus Improves Total Joint Arthroplasty Outcomes

Researchers assessed the effect of preoperative antiviral treatment for hepatitis C virus on the risk for surgical-related complications in patients who underwent total joint arthroplasty.

Preoperative antiviral treatment for hepatitis C virus (HCV) infection was associated with a decreased risk for periprosthetic joint infection (PJI) and other surgical-related complications in patients who underwent total joint arthroplasty (TJA), according to results of a study published in the Journal of Arthroplasty.

In this systematic review and meta-analysis, study researchers compared postoperative outcomes of TJA among patients who were vs those who were not (controls) receiving treatment for confirmed HCV infection by reviewing Relevant studies from PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases conducted through March 2022 were included.

A total of 8 observational studies were included in the meta-analysis, all of which were published between 2019 and 2022 and conducted in the United States. The follow-up duration ranged from 1 year to 63.2 months.

Among 9703 patients included, 2348 received interferon or direct-acting antiviral (DAA)-based therapies, and 2104 were veterans.

In the pooled analysis, researchers observed a decreased risk for both overall complications (odds ratio [OR], 0.67; 95% CI, 0.50-0.89; P =.006) and surgical-related complications (OR, 0.46; 95% CI, 0.30-0.69; P = .0002) among patients who were vs were not receiving treatment for HCV infection.

Subgroup analyses showed that surgical-related complications were more likely among patients in the control group who underwent lower-extremity TJA (OR, 0.41; 95% CI, 0.26-0.64). Patients in the control group also had a significantly increased risk for surgical-related complications (OR, 1.56, 95% CI, 1.17-2.08; P =.003; I2 =36%) compared with those who received preoperative DAA-based therapy.

In regard to mechanical-related complications, including joint dislocation, periprosthetic fracture, and implant loosening during or after hospitalization, no significant between-group differences were observed (OR, 0.80; 95% CI, 0.63-1.02; P =.07). The occurrence of PJI was decreased among patients who received treatment vs those in the control group (2.69% vs 4.93%; OR, 0.45; 95% CI, 0.33-0.62; I2 =16%), with similar findings observed at all postoperative timepoints. The risk for PJI also was significantly increased among patients in the control group (OR, 1.85; 95% CI, 1.39-2.47; P <.0001; I2=0%) vs those who received preoperative DAA-based therapy.

Limitations included the short follow-up duration, as well as potential selection and attrition bias due the inclusion of only observational studies and the lack of randomly assigned patient groups. In addition, differences in regard to the rate of liver dysfunction, antiviral treatments, and type of TJA procedure may have resulted in potential confounding.

“According to the researchers, “Patients [with HCV infection] would benefit from timely diagnosis and antiviral treatment, which should be integrated into the comprehensive optimization protocol of medical comorbidities prior to elective [procedures].”

Disclosure: One or more authors declared affiliations with pharmaceutical, biotech, and/or devise companies. Please see the original reference for a full list of disclosures.


Cheng T, Xu D, Yan Z, Ding C, Yang C, Zhang X. Antiviral treatment for hepatitis C is associated with a reduced risk of periprosthetic joint infection: a meta-analysis of observational studies. J Arthroplasty. Published online April 26, 2022. doi: 10.1016/j.arth.2022.04.027