Does the hepatitis C virus affect the outcomes of total joint arthroplasty? A meta-analysis of ten studies

Background: It is estimated that 3%-8% of orthopedic patients, many of whom may undergo lower extremity total joint arthroplasty (TJA), are infected with hepatitis C virus. However, the impact of this virus on total joint arthroplasty is still undefined. Methods: Eligible studies were searched from electronic databases including PubMed, Web of Science, CNKI and OVID. Two researchers performed data extraction from eligible independently. Quality parameters and risk of bias in the included studies were assessed according to Cochrane's guidelines. The pooled Standardized Mean Difference (SMD) with a 95% CI was used to assess the outcomes of total joint arthroplasty in patients with the hepatitis C virus. Results: A total of 28 articles related to hepatitis C virus and total joint arthroplasty were reviewed. All clinical studies were eliminated and six articles containing ten studies eventually satisfied the eligibility criteria for this study. The pooled analysis showed hepatitis C had a higher complications rate than non-hepatitis C, with the pooled HR values of 1.55 (95% CI = 1.11-2.17, p = 0.01). As for THA, an overall pooled HR value (HR = 2.21, 95% CI = 1.19-4.10, p = 0.012) was obtained, indicating that patients with hepatitis C virus had a higher revision rate than non-hepatitis C. The infection rate was different between hepatitis C patients and non-hepatitis C controls (HR = 1.29, 95% = 1.17-1.44, P = 0.00). The combined analysis revealed a significantly longer length of hospital stay in patients with hepatitis C virus (HR = 0.88, 95% CI = 0.54-1.21, p = 0.000). Conclusions: This is the first systematic review and meta-analysis investigating the impact of hepatitis virus on total joint arthroplasty. Based on this meta-analysis, we can draw a conclusion that the patients with hepatitis C virus have higher rates of complication, infection, and revision compared to patients with non-hepatitis virus. Besides, hepatitis C infected patients require a significant longer hospital stay than patients without hepatitis. (C) 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.