Infection and Mortality Rate in Hepatitis C and Cirrhotic Patients Undergoing Hip and Knee Replacement


Liver disease carries significant risk in total joint arthroplasty (TJA). The authors sought to investigate the complications in hepatitis C virus (HCV) and cirrhosis patients after TJA. PRISMA guidelines extracted ten studies and meta-analytic analysis was performed. Five hundred and twenty-seven patients with liver disease underwent TJA. The complication rate was 38.9%, with 8% infection at 57 months. Cirrhotic patients had higher complication and infection rates compared to HCV patients (p < 0.001, p < 0.039, respectively). Mortality in cirrhosis patients was 17.8% at 36 months. Studies suggested Child Pugh Class A patients had significantly lower complications than Class B or C. One study revealed lower MELD (Model for End-Stage Liver Disease) scores < 10 carry a low mortality risk of 9.8% compared with 32% mortality if MELD score 10 or above. Cirrhosis has significant infection and mortality risk in total hip and knee arthroplasty. Surgeons can risk stratify these patients by MELD score and Child Pugh Class. (Journal of Surgical Orthopaedic Advances 31(1):001–006, 2022) Key words: cirrhosis, hepatitis C virus (HCV), liver disease, complications, infection, mortality, total hip arthroplasty (THA), total knee arthroplasty (TKA)

Zachary C. Lum, DO; Eric G. Kim, DO; Trevor J. Shelton, MD; and John P. Meehan, MD