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The effects of hepatitis C on primary total hip (THA) and knee (TKA) arthroplasties are poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent THA or TKA between 1990 and 2007 without a diagnosis of cirrhosis, HIV, or hepatitis A, B, D or E virus infection. Patients were split into two groups: 1) hepatitis C (n = 26,444) and 2) non-hepatitis C (n = 8,336,882) and analyzed for differences in length of hospital stay, discharge status and perioperative complications. Those with hepatitis C had shorter hospital stays, higher rates of nonroutine discharge and higher odds of in-hospital complications (OR: 1.686, range: 1.645–1.727), surgery related complications (OR: 1.559, range: 1.516–1.603) and general medical complications (OR: 2.012, range: 1.961–2.064) (P < 0.001).