Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty

Cole M Howie; Kyle H Cichos; Mohamed G Shoreibah; Eric M Jordan; Kian R Niknam; Antonia F Chen; Erik N Hansen; Gerald G McGwin Jr; Elie S Ghanem

doi:10.1016/j.arth.2024.01.054

Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty

J Arthroplasty. 2024 Feb 6:S0883-5403(24)00075-5. doi: 10.1016/j.arth.2024.01.054. Online ahead of print.

Authors

Cole M Howie¹, Kyle H Cichos², Mohamed G Shoreibah¹, Eric M Jordan³, Kian R Niknam⁴, Antonia F Chen³, Erik N Hansen⁴, Gerald G McGwin Jr⁵, Elie S Ghanem⁶

Affiliations

¹ Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
² Hughston Foundation, Columbus, Georgia; Hughston Clinic, Columbus, Georgia.
³ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts.
⁴ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California.
⁵ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
⁶ Department of Orthopaedic Surgery, University of Missouri at Columbia, Columbia, Missouri.

PMID: 38331360
DOI: 10.1016/j.arth.2024.01.054

Abstract

Background: African Americans have the highest prevalence of chronic Hepatitis C virus (HCV) infection. Racial disparities in outcome are observed after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study sought to identify if disparities in treatments and outcomes exist between Black and White patients who have HCV prior to elective THA and TKA.

Methods: Patient demographics, comorbidities, HCV characteristics, perioperative variables, in-hospital outcomes, and postoperative complications at 1-year follow-up were collected and compared between the 2 races. Patients who have preoperative positive viral load (PVL) and undetectable viral load were identified. Chi-square and Fisher's exact tests were used to compare categorical variables, while 2-tailed Student's Kruskal-Wallis t-tests were used for continuous variables. A P value of less than .05 was statistically significant.

Results: The liver function parameters, including aspartate aminotransferase and model for end-stage liver disease scores, were all higher preoperatively in Black patients undergoing THA (P = .01; P < .001) and TKA (P = .03; P = .003), respectively. Black patients were more likely to undergo THA (65.8% versus 35.6%; P = .002) and TKA (72.1% versus 37.3%; 0.009) without receiving prior treatment for HCV. Consequently, Black patients had higher rates of preoperative PVL compared to White patients in both THA (66% versus 38%, P = .006) and TKA (72% versus 37%, P < .001) groups. Black patients had a longer length of stay for both THA (3.7 versus 3.3; P = .008) and TKA (4.1 versus 3.0; P = .02).

Conclusions: The HCV treatment prior to THA and TKA with undetectable viral load has been shown to be a key factor in mitigating postoperative complications, including joint infection. We noted that Black patients were more likely to undergo joint arthroplasty who did not receive treatment and with a PVL. While PVL rates decreased over time for both races, a significant gap persists for Black patients.

Keywords: hepatitis C; outcomes; racial disparity; total joint arthroplasty; treatments.