Human immunodeficiency virus in total hip arthroplasty

Human immunodeficiency virus (HIV) is a pandemic affecting more than 35 million people worldwide. The aim of this review is to describe the association between HIV and total hip arthroplasty (THA) and assess patient risk factors to optimize functional outcomes and decrease rates of revision. Since the advent of highly active antiretroviral treatment (HAART), HIV-infected patients are living longer, which allows them to develop degenerative joint conditions. HIV and HAART act independently to increase the demand for THA. HIV-positive patients are also more predisposed to developing avascular necrosis (AVN) of the hip and femoral neck fractures due to decreased bone mineral density (BMD). Prior to the widespread implementation of access to HAART in homogenous cohorts of HIV-infected patients undergoing THA, reports indicated increased rates of complications. However, current literature describes equivocal functional outcomes and survival rates after THA in HIV-positive patients controlled on HAART when compared to HIV-negative controls. HIV-infected patients eligible for THA should be assessed for medical co-morbidities and serum markers of disease control should be optimized. Periprosthetic joint infection (PJI) is a leading cause of revision THA, and HIV is a modifiable risk factor. Importantly, the significance is negated once patients are placed on HAART and achieve viral suppression. THA should not be withheld in HIV-infected patients injudiciously. However, HIV is a burgeoning epidemic and all patients should be identified and started on HAART to avoid preventable peri-operative complications. Cite this article: EFORT Open Rev 2020;5:164-171. DOI: 10.1302/2058-5241.5.190030

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Complications of primary total hip arthroplasty in human immunodeficiency virus-positive patients with femoral head osteonecrosis

Hip International ◽

10.1177/11207000211005750 ◽

2021 ◽

pp. 112070002110057

Author(s):

Tyler R Youngman ◽

Dietrich W Riepen ◽

Dustin B Rinehart ◽

Dharani Rohit Thota ◽

Joshua J Sun ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Complication Rate ◽

Hiv Positive ◽

Total Hip ◽

Femoral Head Osteonecrosis ◽

Immunodeficiency Virus ◽

The Mean

Background: Femoral head osteonecrosis (FHON) is a well-recognised complication in patients with human immunodeficiency virus (HIV) infection. Total hip arthroplasty (THA) is a reliable solution to FHON and has provided functional improvement and pain relief in these patients. Higher complication rates, in particular infections, have been reported in the series of THAs done in the HIV-positive patients. The purpose of this study was to evaluate the complication rate of THA for FHON in HIV-positive patients managed with the highly active antiretroviral therapy (HAART) protocols. Methods: A retrospective review was performed of HIV-positive patients with FHON who underwent THAs over a 10-year period at a single institution. Results: A total of 56 THAs (44 patients) met the inclusion criteria. The mean age at the time of THAs was 47 (range 34–60) years. Of the 44 patients, 39 (88.6%) were males. The mean follow-up was 6.6 (range 2.0–11.3) years. The overall complication rate was 12.5%, with 2 (3.6%) cases of deep periprosthetic infections. Conclusions: HIV-positive patients with FHON undergoing THAs do have a considerable complication rate (12.5%). The deep periprosthetic infection rate (3.6%) in these patients, however, has decreased with contemporary disease modification protocols.

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Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01827-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Carol A. Lin ◽

Phillip H. Behrens ◽

Guy Paiement ◽

W. David Hardy ◽

James Mirocha ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Total Hip Arthroplasty ◽

Surgical Site Infection ◽

Hip Arthroplasty ◽

Site Infection ◽

Metabolic Factors ◽

Total Hip ◽

Immunodeficiency Virus ◽

Post Traumatic ◽

Traumatic Arthritis

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Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm11010122 ◽

2021 ◽

Vol 11 (1) ◽

pp. 122

Author(s):

Christopher W. Day ◽

Kerry Costi ◽

Susan Pannach ◽

Gerald J. Atkins ◽

Jochen G. Hofstaetter ◽

...

Keyword(s):

Mortality Rate ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Functional Outcomes ◽

Joint Infection ◽

Harris Hip Score ◽

Worst Case ◽

Total Hip

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties. Infection resolution was defined as no clinical nor laboratory evidence of infection at 24 months after the last surgery and after a minimum of 12 months following cessation of antimicrobial treatment. Four patients died within 24 months of their final surgery. Nineteen patients, 73% (worst-case analysis (wca) 63%), were infection free after 1 surgery; 22 patients, 85% (wca 73%), were infection free after 2 surgeries; and 26 patients, 100% (wca 87%), were infection free after three and four surgeries. The median Harris Hip Score was 41 prior to first revision surgery and improved to 74 at twelve months and 76 at ten years after the final surgery. Thirteen patients died at a mean of 64 months from first revision, giving a mortality rate of 43% at ten years, which is approximately 25% higher than that of an age-matched general population. The results show that with repeated aggressive surgical treatment, most PJIs of the hip are curable. Ten years after successful treatment of PJI, functional outcomes and pain are improved and maintained compared to before initial surgery, but this must be balanced against the high 10-year mortality. Level of evidence: cohort studies.

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