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Master of Public Health

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

AUTHORS

Howie C , Cichos KH , Shoreibah M , Jordan E , Niknam K , Chen AF , Hansen EN , McGwin G , Ghanem ES , . The Journal of arthroplasty. 2024 2 6; ().

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 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 two races. Patients who have preoperative positive viral load (PVL) and undetectable viral load (UVL) were identified. Chi-square and Fisher’s exact tests were used to compare categorical variables, while two-tailed Student’s Kruskal-Wallis t-tests were used for continuous variables. A P-value of less than 0.05 was significant.

RESULTS: The liver function parameters, including AST (aspartate aminotransferase) and MELD (model for end-stage liver disease) scores, were all higher preoperatively in Black patients undergoing THA (P =0.01; P <0.001) and TKA (P =0.03; P =0.003) respectively. Black patients were more likely to undergo THA (65.8 versus 35.6%; P =0.002) 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=0.006) and TKA (72 versus 37%, P<0.001) groups. Black patients had a longer LOS (length of stay) for both THA (3.7 versus 3.3; P =0.008) and TKA (4.1 versus 3.0; P =0.02).

CONCLUSIONS: The HCV treatment prior to THA and TKA with UVL 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.

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