Operations about Hip in Human Immunodeficiency Virus-Positive Patients

Abstract

BackgroundThe number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.MethodsThis study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).ResultsThe preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.ConclusionsThere were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.

Total hip arthroplasty inHIV‐infected patients: a retrospective, controlled study

“…A very similar study, carried out by Christopher Lehman et al in 29 HIV-positive patients who underwent surgery between 1983 and 1995, also showed that this poor prognosis was even worse in patients with IDU antecedents [21]. More recent studies in the HAART era, however, have revealed lower infection rates in HIV-positive patients, but none of them compared the results with those for non-HIVinfected patients [28][29][30][31][32][33]. In 2005, Craig Mahoney et al reported their results for a group of 40 HIV-infected patients in whom acute infection rates in the immediate postoperative stage had been lower than expected [28].…”

“…More recent studies in the HAART era, however, have revealed lower infection rates in HIV‐positive patients, but none of them compared the results with those for non‐HIV‐infected patients . In 2005, Craig Mahoney et al .…”

Necrose avascular da cabeça femoral em pacientes HIV positivos: resultados iniciais do tratamento cirúrgico por substituição articular cerâmica-cerâmica

“…Although many patients do not present any specific identified etiological factor, the risk factors and conditions have been well determined in the literature (10) . The incidence of osteonecrosis of the femoral head in the general population ranges from 0.010 to 0.135%, while in the HIV-positive population it ranges from 1.33 to 4.4% (3,11,12) . The Osteo-HIV service of the Institute of Orthope- Chart 2 -WOMAC score before the operation and after six and twelve months of follow-up, and presence of dyslipidemia and lipodystrophy.…”

“…The patients' young age group, high demand on the joints and risk of harm to renal function due to release of metal particles explain why joint surfaces made of ceramic and uncemented acetabular and femoral components made of porous metal are chosen. These characteristics provide high durability for the implants, with preservation of the bone stock, longer intervals until surgical revision is needed, low production of joint metalosis, low incidence of aseptic loosening and low systemic and local risks (12,17,18) . The decreases in WOMAC score among these patients, six and twelve months after the operation, demonstrate that there were significant improvements regarding pain, locomotor function and quality of life.…”

HIV Infection: Implications on Surgical Practice

“…There was no correlation between CD4+ counts and infection (Habermann et al, 2008). The experience with total joint replacements in HIV populations has been generally favorable, (Habermann et al, 2008;Mahoney et al, 2005;Hicks et al, 2001;Mahoney et al, 2005;Hicks et al, 2001), although the experience of some workers has been less than favorable, with most citing high infectious complication rates (Parvizi et al, 2003;Luck Jr, 1994), there is a growing body of evidence that appropriate preoperative screening of patients, availability of HAART, antibiotic cover, and improved technique have seen a gradual improvement in outcomes after joint arthroplasties, with low rates of complications (Yoo et al, 2010). The success in joint replacement must be tempered by the need for correct diagnosis in the face of unusual presentations of disease processes in HIV/AIDS (Agarwal et al, 2005).…”