Association of hepatitis B infection with high-risk complications in total joint arthroplasty.
BACKGROUND
An increasing number of patients with hepatitis B virus (HBV) infection are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations and the purpose of this study is to assess the effect of HBV infection on the prognosis TJAs.


METHODS
We retrospectively reviewed patients who underwent elective primary hip and knee arthroplasties in Shanghai Huashan Hospital from 2013 to 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 196 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects.


RESULTS
Among all the patients with TJAs, 5.5% of patients were infected with HBV for the first time. The incidence rate of complications in patients after arthroplasty with hepatitis B infection was significantly higher than that in patients without hepatitis B (10.2% compared to 4.7%, P < 0.01). Surgical related complications (6.1% compared to 3.4%) and general medical complications (4.1% compared to 1.3%) were higher than those in non-B hepatitis group. Compared with non-B hepatitis group, the overall risk of hepatitis B infection increased by 25% (95% CI, 1.04-1.46; p < 0.01). Similar results were obtained for medical and surgical complications. HBV infection presented a 31% increased risk (95% CI, 1.02-1.62; p < 0.01) for medical complication and an 18% increased risk (95% CI, 1.10-1.26; p < 0.01) for surgical complication. No statistical difference was found between the surgical methods and sex. However, a significant difference of C-reactive protein (CRP) level was found between HBV infection group and the matched non-infected group (P < 0.01).


CONCLUSION
This is the first study to investigate the risk of perioperative complications of hepatitis B in Chinese TJAs patients. In consideration of the large population of HBV infection in China, more attention and medical care should be provided to patients with HBV infection who need to undergo TJA operation.
['Wang|Jin|J|', 'Zhao|Guanglei|G|', 'Chen|Jie|J|', 'Xia|Jun|J|', 'Wang|Siqun|S|', 'Huang|Gangyong|G|', 'Chen|Feiyan|F|', 'Shi|Jingsheng|J|', 'Yang|Yuanqing|Y|', 'Wei|Yibing|Y|']
D000368:Aged D019644:Arthroplasty, Replacement, Hip D019645:Arthroplasty, Replacement, Knee D002097:C-Reactive Protein D002681:China D005260:Female D005500:Follow-Up Studies D006515:Hepatitis B virus D019694:Hepatitis B, Chronic D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D010003:Osteoarthritis D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D016896:Treatment Outcome
Hepatitis B infection Complication Total joint arthroplasty Risk factor