Preoperative antiviral therapy decreases the risk for postoperative complications in patients with chronic hepatitis B virus (HBV) infection undergoing total hip arthroplasty (THA), according to study findings published in the Journal of Arthroplasty.
Researchers conducted a multicenter retrospective cohort study between January 2012 and December 2017 to evaluate the effects of preoperative antiviral therapy among patients with chronic HBV infection undergoing THA. Propensity-score matching was used to match patients who received preoperative antiviral therapy (n=156) in a 1:3 fashion against those who received no therapy (controls; n=468). Perioperative, postoperative, and surgical complications were compared between the 2 patient groups.
Among patients included in the treatment (n=156) and control (n=762) groups prior to propensity-score matching, the mean age was 64 (range, 53-78) and 62 (range, 47-83) years, 65.4% and 52.6% were women, 17.9% and 32.2% were current smokers, 13.5% and 28.1% consumed more than 50 g of alcohol daily, and the mean Charlson comorbidity index (CCI) score was 1.8 (range, 0-5) and 1.4 (range, 0-6), respectively. Of note, CCI scores excluded liver disease and liver cancer.
Compared with patients who received preoperative antiviral therapy, significant increases were noted among those in the control group for the following outcomes:
- mean operating times (82 vs 76 min; P =.007);
- mean blood loss (515 vs 465 mL; P =.03);
- surgical complications (25.4% vs 16.7%; P =.01);
- length of hospitalization (6.2 vs 5.4 days; P =.0005);
- readmissions (12.4% vs 5.8%; P =.02);
- reoperations (16.7% vs 9.6%; P =.03); and
- implant revisions (11.1% vs 4.5%; P =.02)
Patients in the treatment and control groups did not significantly differ in regard to the overall rate of medical complications within 90 days after THA (26.5% vs 23.1%; P =.046), including kidney insufficiency, venous thromboembolism, or mortality.
Multivariable logistic regression was then performed, with adjustments for patient age, sex, BMI, smoking status, alcohol consumption, and comorbidities. Results showed that in patients with liver fibrosis, all-type complications (odds ratio [OR], 0.49; 95% CI, 0.3-0.80; P =.004), postoperative joint infections (OR, 0.37; 95% CI, 0.16-0.86; P =.02), reoperations (OR, 0.40; 95% CI, 95% CI, 0.19-0.84; P =.02), and implant revisions (OR, 0.30; 95% CI, 0.11-0.82; P =.02) were significantly less likely among those in the treatment vs control groups.
Study limitations include the retrospective design, as well as potential selection bias, confounding bias, and information bias.
According to the researchers, “eligible patients are recommended to receive modern day [antiviral therapy], and elective THAs should be delayed until maintained virological control has been at least attempted.”
Cheng T, Li G, Ning H, Hao L. Antiviral therapy for chronic hepatitis B infection improves outcomes after total hip arthroplasty: a multicenter retrospective study. J Arthroplasty. Published online August 11, 2022. doi:10.1016/j.arth.2022.08.005