Limited evidence supports that patients with cirrhosis or hepatitis C are at higher risk for complications with total knee arthroplasty (TKA).

Rationale
Given that the liver is the target organ for hepatitis C, these two risk factors were grouped together. Shih (2004) demonstrated higher complication rates after total knee arthroplasty in patients with cirrhosis and was assigned moderate quality. Pour (2011) was lower quality paper that demonstrated the same in patients with hepatitis C virus status alone and without liver damage. Given the one moderate study and one low quality study, the recommendation was made that limited evidence supports that patients with cirrhosis or hepatitis C are at higher risk for complications with total knee arthroplasty.
 
  1. Pour,A.E., Matar,W.Y., Jafari,S.M., Purtill,J.J., Austin,M.S., Parvizi,J. Total joint arthroplasty in patients with hepatitis C. J Bone Joint Surg Am 2011/8/3; 15: 1448-1454
  2. Shih,L.Y., Cheng,C.Y., Chang,C.H., Hsu,K.Y., Hsu,R.W., Shih,H.N. Total knee arthroplasty in patients with liver cirrhosis. J Bone Joint Surg Am 2004/2; 2: 335-341