Published online Nov 18, 2022. doi: 10.5312/wjo.v13.i11.1015
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
Processing time: 450 Days and 0.7 Hours
Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might have been underestimated.
To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.
We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Re
Six human and four animal studies were eligible for inclusion in the qualitative synthesis. Hepatitis C virus was implicated in several peri- and post-operative complications in patients without cirrhosis after major orthopedic surgery. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.
Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis. Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms. Therefore, based on our literature search, the proposed clinical and pathogenetic classification scheme is as follows: (1) Viral infections of bone or joint; (2) Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues; and (3) Viral infection as a risk factor for post-surgical bacterial infection.
Core Tip: Viral infections can include multiple orthopedic manifestations, thus resulting in significant distress. In addition, the outcome of orthopedic surgeries may be influenced by certain chronic viral infections such as hepatitis C virus. There is evidence of autoimmune-mediated mechanisms, immunosuppression, and perhaps direct viral infection provoking this, although the precise mechanisms have yet to be fully understood. In this review, a classification scheme was proposed. However, further research is needed to unveil the relative contributions of the identified mechanisms and develop novel preventative and treatment strategies.