Curtailing infection risks in hepatitis C patients: the effect of antiviral treatment in revision shoulder arthroplasty

Daniel Hameed; Brian Shear; Jeremy Dubin; Ethan Remily; Sandeep S Bains; Zhongming Chen; Michael A Mont; S Ashfaq Hasan; Mohit N Gilotra

doi:10.1016/j.jse.2023.10.030

Curtailing infection risks in hepatitis C patients: the effect of antiviral treatment in revision shoulder arthroplasty

J Shoulder Elbow Surg. 2023 Dec 16:S1058-2746(23)00857-1. doi: 10.1016/j.jse.2023.10.030. Online ahead of print.

Authors

Daniel Hameed¹, Brian Shear², Jeremy Dubin¹, Ethan Remily¹, Sandeep S Bains¹, Zhongming Chen¹, Michael A Mont¹, S Ashfaq Hasan², Mohit N Gilotra³

Affiliations

¹ LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
² Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
³ Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: mgilotra@som.umaryland.edu.

PMID: 38104720
DOI: 10.1016/j.jse.2023.10.030

Abstract

Background: Revision shoulder arthroplasty (RevSA) is a complex procedure that can result in various postoperative complications. However, the impact of hepatitis C virus (HCV) on postoperative complications after RevSA remains unclear because of limited and inconsistent evidence. This study aims (1) to investigate the incidence of postoperative complications in patients with HCV undergoing RevSA and (2) to evaluate the impact of HCV treatment on complication rates at different time points after the revision procedure, specifically at 90 days, 1 year, and 2 years.

Methods: We queried a national, all-payer database to investigate recent trends in the use of RevSA among HCV patients to assess postoperative complication rates, including venous thromboembolism (VTE), wound complication, transfusion, and periprosthetic joint infection (PJI). Statistical analyses involved propensity score matching to create balanced cohorts and logistic regression to determine the relative risk of postoperative complications. Data were analyzed with SPSS software (version 24.0 for Windows). The study included patients who underwent partial or total RevSA procedures between January 1, 2010, and December 31, 2020. Patients were identified based on medical claims that included procedural codes for RevSA and associated diagnosis codes for PJI or insertion/removal of an antibiotic spacer. A Bonferroni correction was used because many tests were performed and statistical significance was set at P = .0125.

Results: The HCV cohort demonstrated higher PJI rates at 1-year (5.5% vs. 3.9%, P = .006) and 2-year follow-ups (6.7% vs. 4.6%, P = .006). However, no significant differences emerged in VTE and wound complication rates between the HCV and non-HCV cohorts. Comparing untreated and treated HCV patients, the former showed significantly higher PJI rates at 2 years (P = .010), whereas the treated group had significantly lower odds ratios for PJI. When comparing treated HCV patients with the non-HCV cohort, minimal differences were found in postoperative outcomes, indicating no significant difference in the risk of complications between the groups.

Conclusion: Our study observed an association between HCV patients who received antiviral treatment prior to RevSA and a reduced incidence of PJI compared to untreated HCV patients. When comparing this group to the non-HCV controls, there was no significant difference in the incidence of PJI, suggesting a potential association between antiviral treatment and the observed risk patterns in HCV patients. Proper management of HCV-positive patients during RevSA is crucial for improving outcomes and reducing complications.

Keywords: HCV treatment; Revision shoulder arthroplasty; hepatitis C virus; incidence; postoperative complications; prosthetic joint infection; retrospective cohort study; surgical site infection.