Hepatitis C patients with fibrosis have more complications after TJA

Patients with hepatitis C patients perform similarly to control patients after elective total joint arthroplasty. However, patients with hepatic fibrosis have greater infection rates and patients with thrombocytopenia experienced more complications.

Between January 2006 and May 2011, researchers identified 72 patients with hepatitis C who underwent 77 primary total joint arthroplasty (TJA). They stratified the patients by fibrosis and thrombocytopenia and compared them to matched controls.

Researchers found showed similar outcomes between hepatitis C and control patients. The rate of infection which required irrigation and debridement was the same between patients with hepatitis C and the control group. Infection rates were higher for patients with thrombocytopenia compared to patients with hepatitis C who did not have thrombocytopenia. According to study results, fibrotic hepatitis C patients experienced a greater average decrease in hemoglobin after total knee arthroplasty, as well as greater deep infection rate and rate of cellulitis vs. the non-fibrotic hepatitis C patients.

"Liver function tests (LFT) may ascertain which hepatitis C patients are at significant risk of complication following TJA," the researchers wrote. "In our practice, liver function tests are not routinely ordered in the preoperative assessments. However, LFTs, including aminotransferase to platelet ratio index and fibrosis 4, may be useful to stage fibrosis and thrombocytopenia when liver dysfunction is suspected."

Disclosure: Ong is a paid consultant for Stryker and Smith & Nephew and receives research support from Zimmer and Baxter. Orozco is a paid consultant for and receives research support from Stryker.