Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2022; 13(11): 1015-1028
Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.1015
Viral infections in orthopedics: A systematic review and classification proposal
Konstantinos Sidiropoulos, Savvas Ilias Christofilos, Konstantinos Tsikopoulos, Dimitrios Kitridis, Lorenzo Drago, Gabriele Meroni, Carlo Luca Romanò, Venu Kavarthapu
Konstantinos Sidiropoulos, General Hospital of Serres, Serres 62100, Greece
Savvas Ilias Christofilos, Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, United Kingdom
Konstantinos Tsikopoulos, Department of Orthopaedics, 404 Army General Hospital, Larissa 41222, Greece
Dimitrios Kitridis, the First Department of Orthopaedics, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Lorenzo Drago, Department of Biomedical Sciences for Health and Microbiome, University of Milan, Milan 20133, Italy
Gabriele Meroni, Department of Biomedical, Surgical, and Dental Sciences, One Health Unit, University of Milan, Milan 20133, Italy
Carlo Luca Romanò, Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, Milan 20100, Italy
Venu Kavarthapu, Trauma, and Orthopaedics, Kings College Hospital London, Denmark Hill, London SE59RS, United Kingdom
Author contributions: Drago L and Kavarthapu V were involved in the study's conceptualization; Tsikopoulos K and Sidiropoulos K conducted the literature research and extracted relevant information; Tsikopoulos K and Kitridis D assessed the quality of the included studies; Christofilos SI and Meroni G were involved in the generation of tables and writing the paper; Drago L, Kavarthapu V, and Romanò CL supervised the paper and revised the paper accordingly.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Savvas Ilias Christofilos, MD, Doctor, Department of Genetics, Evolution, and Environment, University College London, London WC1E 6BT, United Kingdom. savvaschristofilos@gmail.com
Received: August 23, 2021
Peer-review started: August 26, 2021
First decision: November 17, 2021
Revised: December 1, 2021
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 18, 2022
ARTICLE HIGHLIGHTS
Research background

While the influence of microbial infections on orthopedic clinical outcomes is well documented, the impact of viral infections on the musculoskeletal system has been inadequately investigated.

Research motivation

Although microbial infections have been studied extensively in orthopedics, the impact of viral infections on orthopedics has not been sufficiently investigated. In addition, we are unaware of any classifications relating to viral infections in the orthopedic literature.

Research objectives

In this article, we looked at the risk factors for persistent arthritis development after a viral infection and the impact of viral infections on orthopedic clinical outcomes. In addition, we categorized orthopedic manifestations of viral infections relative to their causative mechanism.

Research methods

An extensive literature search was performed to identify completed studies published before January 30, 2021. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Reference Citation Analysis, and Scopus were searched for articles evaluating risk factors and bone/joint manifestations of viral infection in animals and humans. In addition, we assessed the quality of the included articles utilizing SYRCLE's risk of bias tool for animal studies, the Moga score for case series, the Wylde score for registry studies, and the Newcastle-Ottawa Scale for Case-control studies.

Research results

Ten articles were included in the systematic review. Of these, two dealt with treatment strategies and another three with arthroplasties in patients with hepatitis C virus (HCV). In addition, six articles addressed human beings investigating Chikungunya, HCV, and RRVs. After major orthopedic surgery, HCV was implicated in several peri- and post-operative complications. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses negatively influence bones and/or joints, resulting in viral arthritis and bone loss.

Research conclusions

Viral infections pose a significant burden in orthopedics due to the significant impact on patient quality of life. We have demonstrated a connection between viral infections and orthopedic surgical outcomes. We highlight that arthralgia, myalgia, and transient arthritis could result from viral infection or secondary immune processes, although each mechanism's contribution is still relatively unclear. We advocate that the present systematic review raises awareness of the implications of viral infections in orthopedics and acts as a guide for orthopedic surgeons to classify them in a clinical and pathogenetic fashion.

Research perspectives

We recommend that a consistent definition of virus-induced rheumatoid arthritis be developed. Furthermore, we suggest that further high-quality articles investigating novel treatment options based on the underlying mechanisms be conducted.