The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Maharaj, Zia; Pietrzak, J; Sikhauli, Nkhodiseni; Jagt, Dick van de; Mokete, Lipalo

doi:10.1051/sicotj/2019042

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Our results appear to reflect these data, with our HCV cohort having a 5.5% higher complication rate. It has also been shown that a majority of TJA HIV patients are younger on average and undergo THA (up to 79%) [11,21]. Our data do not reflect this surgical distribution, with half of HIV patients undergoing THA, but do reflect the age distribution with our HIV cohort averaging 56 years at age of surgery, much lower than the usual age of 68 years for THA [11,22].…”

Section: Discussioncontrasting

confidence: 71%

Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty

Fang

Cornell

Dicken

et al. 2020

SICOT-J

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Introduction: As advances in efficacy of human immunodeficiency virus (HIV) and hepatitis-C virus (HCV) anti-viral medications increase, patients are able to maintain higher quality of lives than ever before. While these patients live longer lives, the unique patient population of those co-infected with both HIV and HCV increases. As these older patients seek orthopaedic care, it is important to understand their unique outcome profile. The purpose of this study was to evaluate the complication rate after total joint arthroplasty (TJA) in patients with HIV and HCV coinfection compared with patients with HIV or HCV only. Methods: A retrospective review of patients undergoing primary total joint arthroplasty (TJA) at our urban, academic hospital between April 2016 and April 2019 was conducted. Patients were stratified into three groups according to viral status: HIV only, HCV only, or HIV and HCV coinfection. Baseline demographics, intravenous drug (IV) use, surgery type, CD4+ count, follow-up and complications were analysed. Results: Of the 133 patients included in the study, 28 had HIV, 88 had HCV and 17 were coinfected with both HIV and HCV. Coinfected patients were more likely to have a lower BMI (p < 0.039) and a history of IV drug use (p < 0.018) compared to patients with either HIV or HCV only. Coinfected patients had a higher complication rate (41%) than both HIV only (7%; p < 0.001) and HCV only (12.5%; p < 0.001) patients. Discussion: Patients coinfected with HIV and HCV undergoing TJA have a higher complication rate than patients with either infection alone. As this unique population of coinfected patients continues to expand, increasingly they will be under the care of arthroplasty surgeons. Improved awareness and understanding of the baseline demographic differences between these patients is paramount. Recognition of the increased complication rates grants the opportunity to improve their orthopaedic care through preoperative and multidisciplinary management.

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Section: Discussioncontrasting

confidence: 71%

Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty

Fang

Cornell

Dicken

et al. 2020

SICOT-J

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“…The HIV percentage was comparative to that of a local study by Maharaj et al who quoted a figure of 6% seroprevalence in their patient population of 1 007 who had undergone TKA. 15 Of the 20 patients with HIV, only one complication occurred in a patient with OA who developed a DVT. This mirrors conclusions drawn in an article by Boylan et al, who found that HIV did not increase their TKA patients' overall risk of complications.…”

Section: Discussionmentioning

confidence: 98%

A retrospective comparative study of complications after total knee replacement in rheumatoid arthritis and osteoarthritis patients

Nansook

Ryans

2022

SA orthop. j.

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BACKGROUND: Total knee arthroplasty (TKA) rates have significantly increased over the past few decades; consequently, so too have the absolute number of complications. International literature expounds on complications in the rheumatoid arthritis (RA) and osteoarthritis (OA) subgroups from the developed context, but these findings cannot be generalised to the developing world, where access to medication, medical facilities and patient characteristics may differ. The purpose of this study was to determine the comparative rates and nature of complications that occur post total knee arthroplasty in RA and OA patients at a single South African quaternary hospital. METHODS: This was a retrospective comparative study of complication rates in two groups following TKA at Inkosi Albert Luthuli Central Hospital (IALCH) arthroplasty unit, between 1 January 2014 and 29 February 2020. The data was collected retrospectively, utilising the digitised patient management system at the hospital. Data extraction included patient demographics, time to surgery, indication for surgery and early complication rates. Descriptive analysis was performed to quantify complications, comparing the two groups. RESULTS: The chart review yielded 332 cases, comprising 41 RA and 291 OA patients. The mean age of the combined participant group was 65 years (standard deviation [SD] 8). Most cases were female (87%, 289 of 332), with males comprising 13% (43 of 332). Concomitant human immunodeficiency virus (HIV) was present in 6% of patients (20 of 332), and 24% (80 of 332) had diabetes mellitus (DM). The absolute number of complications was greater in the OA group, where revision surgery was performed in 3% (8 of 291) of cases, infection occurred in 1% (3 of 291), mechanical complications in 3% (10 of 291), and deep vein thrombosis (DVT) in 1% (2 of 291) of cases. There was one complication, a DVT, in the RA group (2%, 1 of 41). CONCLUSION: In the current study, complications after TKA occurred predominantly in the OA group, 8% (23 of 291) as compared to the RA group, 2% (1 of 41). Complications included DVT, revision surgery, infection and mechanical complications. The study was underpowered to detect significant differences between the groups. Further large-scale investigation will be required to determine if differences in complication rate are significant when low complication incidence is anticipated. Level of evidence: Level 4.

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“…22 In a study of 1 007 TJA patients in South Africa, the seroprevalence of HIV in patients for THA was higher than the general population. 21 Furthermore, the 2018 International Consensus on Orthopaedic Infections determined that HIV is an independent risk for PJI. 23 This emphasises the importance of ASB in HIV-positive patients that may determine a further predisposing risk factor for PJI.…”

Section: Discussionmentioning

confidence: 99%

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

et al. 2021

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BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country

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The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Cited by 5 publications

References 15 publications

Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty

Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty

A retrospective comparative study of complications after total knee replacement in rheumatoid arthritis and osteoarthritis patients

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

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