A meta-analysis of postoperative outcomes of patients with and without chronic hepatitis C undergoing primary total hip or knee arthroplasty

Abstract

Purpose: This investigation provides a rigorous systematic review of the postoperative outcomes of patients with and without chronic hepatitis C who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We queried PubMed, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science and the 'gray' literature, including supplemental materials, conference abstracts and proceedings as well as commentary published in various peer-reviewed journals from 1992 to present to evaluate studies that compared the postoperative outcomes of patients with and without chronic hepatitis C who underwent primary THA or TKA. This investigation was registered in the PROSPERO international prospective register of systematic reviews and follows the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In our literature search, we identified 14 articles that met our inclusion criteria and were included in our fixed-effects meta-analysis. The postoperative outcomes analyzed included periprosthetic joint infection (PJI), aseptic revision, non-homebound discharge and inpatient mortality.

Results: Our statistical analysis demonstrated a statistically significant increase in postoperative complications of patients with chronic hepatitis C who underwent primary THA or TKA including PJI (odds ratio (OR): 1.98, 95% CI: 1.86 - 2.10), aseptic revision (OR: 1.58, 95% CI: 1.50 - 1.67), non-homebound discharge (OR: 1.31, 95% CI: 1.28- 1.34) and inpatient mortality (OR: 9.37, 95% CI: 8.17 - 10.75).

Conclusion: This meta-analysis demonstrated a statistically significant increase in adverse postoperative complications in patients with chronic hepatitis C who underwent primary THA or TKA compared to patients without chronic hepatitis C.

Keywords: chronic hepatitis C; postoperative outcomes; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty.

Figure 1

Forest plot for meta-analysis of the association between chronic HCV infection and risk of PJI, including estimates with and without adjustment/matching. The center of each bar is the study-specific point estimate of the OR, and the bar itself is the associated 95% CI. The bar thickness corresponds to how much weight the study received in the pooled estimate. Study 6: Bendich et al. (7); Study 9: Best et al. (13); Study 12: Cancienne et al. (14); Study 33: Issa et al. (16); Study 36: Kildow et al. (17); Study 43: Mahure et al. (18); Study 50: Novikov et al. (19); Study 51: Orozco et al. (20); Study 55: Pour et al. (21); Study 65: Schwarzkopf et al. (8); Study 151: Bedair et al. (6); Study 525: Mahure et al. (23).

Figure 2

Forest plot for meta-analysis of the association between chronic HCV infection and risk of PJI, including only estimates with adjustment/matching. The center of each bar is the study-specific point estimate of the OR, and the bar itself is the associated 95% CI. The bar thickness corresponds to how much weight the study received in the pooled estimate. Study 6: Bendich et al. (7); Study 12: Cancienne et al. (14); Study 33: Issa et al. (16); Study 36: Kildow et al. (17); Study 50: Novikov et al. (19); Study 51: Orozco et al. (20); Study 55: Pour et al. (21); Study 65: Schwarzkopf et al. (8).

Figure 3

Forest plot for meta-analysis of the association between chronic HCV infection and risk of aseptic revision. The center of each bar is the study-specific point estimate of the OR, and the bar itself is the associated 95% CI. The bar thickness corresponds to how much weight the study received in the pooled estimate. Study 12: Cancienne et al. (14); Study 36: Kildow et al. (17); Study 50: Novikov et al. (19); Study 51: Orozco et al. (20); Study 55: Pour et al. (21).

Figure 4

Forest plot for meta-analysis of the association between chronic HCV infection and risk of non-homebound discharge. The center of each bar is the study-specific point estimate of the OR, and the bar itself is the associated 95% CI. The bar thickness corresponds to how much weight the study received in the pooled estimate. Study 9: Best et al. (13); Study 43: Mahure et al. (18); Study 50: Novikov et al. (19); Study 65: Schwarzkopf et al. (8); Study 525: Mahure et al. (23).

Figure 5

Forest plot for meta-analysis of the association between chronic HCV infection and risk of inpatient mortality. The center of each bar is the study-specific point estimate of the OR, and the bar itself is the associated 95% CI. The bar thickness corresponds to how much weight the study received in the pooled estimate. Study 43: Mahure et al. (18); Study 65: Schwarzkopf et al. (8); Study 525: Mahure et al. (23).