Viral infections in orthopedics: A systematic review and classification proposal

Table 4 Proposed viral classification scheme

Proposed pathogenetic mechanism	Viruses involved	Evidence supporting the proposed mechanism
Direct infection and subsequent inflammation	Ross Rover and Zika viruses	RRV causes arthritis with its RNA coinciding with the appearance of symptoms; Evidence of human osteoblasts being primarily infected
Inflammation primarily through autoimmune mechanisms such as cross-reactivity	CHIKV	CHIKV causes arthritis in the absence of evident infection. Other supporting information includes rheumatoid factor negative RA and exclusive presence in the synoviocytes. Animal studies implicate a potential role of primary infection
Systemic manifestations resulting in immunosuppression	HCV and HIV	Greater rates of microbial infections in HCV patients post-surgery. Greater rates of infections post-surgery pre-HAART. High rates of mechanical and medical comorbidities

RRV: Ross River virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; CHIKV: Chikungunya virus; HAART: Highly active antiretroviral therapy; RA: Rheumatoid arthritis; hOBs: Human osteoblasts.