CLINICAL ARTICLE

 

Hip arthroplasty in HIV-infected patients

 

 

Dr S Brijlall

FCS(SA)Ortho Department of Orthopaedic Surgery, Nelson Mandela Medical School, University of KwaZulu-Natal

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SUMMARY

We conducted a prospective study evaluating the clinical outcome of the arthroplasty in HIV-infected patients. Between July 2000 to August 2001, 14 patients (mean age 42 years) underwent uncemented total hip replacement for osteonecrosis (10 patients) and neglected neck of femur fractures (four patients). Patients were classified according to the WHO and CDC classification and were operated by a single surgeon using the Hardinge approach. At a mean follow-up of 72 months, all patients were fully ambulant. The mean total lymphocyte count (TLC) was 2.24 cells/mm³, CD4-425 cells/mm³, CD8-873 cells/mm³ and CD4 /CD8-0.52. In three patients the CD4 counts declined to <200 and they are presently receiving antiretroviral therapy. There was no loosening, infection or dislocation. One patient sustained a periprosthetic fracture which was treated successfully non-operatively.
We conclude that total hip replacement in HIV-infected patients who have not progressed to WHO stage IV can be rewarding and the procedure does not carry an increased risk of postoperative infection.

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References

1. Hick JL, Ribbans WJ, Buzzard B, Kelly SS, Toft L, Toni Cr, Wiedel JD, York J. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg (BR) 2001;83:1050.         [ Links ]

2. Luck JV, Logan LR, Benson DR, Glasser DB. Human immunod-eficiency Virus infection: complications and outcome of orthopaedic surgery. JM Acad Ortho Surg 1996;4;297-304.         [ Links ]

3. Harrison WJ. HIV/AIDS in trauma and orthopaedic surgery. (Br) 2005;87B:1178-81.         [ Links ]

4. Savioz D, Chilcot M, Sudvig C et al. Preoperative counts of CD4 T-lymphocytes and early postoperative infective complications in HIV positive patients. Aus J Surg 1998;164;483-7.         [ Links ]

5. Tran HS, Moncure M, Tarnott M et al. Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg 2000;180;228-33.         [ Links ]

6. Green WB, De Gnor LT, White GC. Orthopaedic procedure and progress in haemophilia patients who are seropositive for human immunodeficiency virus. Am J of Bone & Joint Surg 1990;724:2-11.         [ Links ]

7. Hoekman P, Van Der Perre P, Nelissen J. Increased frequency of infection after open reduction of fractures in patients who are seropositive for human immunodeficiency virus. Am J of Bone & Joint Surg 1991;73A:675-9.         [ Links ]

8. Merle A, d'Aubigne R, Postel M. Functional results of hip arthroplasty with acrytic prosthesis. J Bone Joint Surg 1954;36-A:451-75.         [ Links ]

9. Eng CA, MAssin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Chin Orthop 1990;257:107-28.         [ Links ]

10. Delee JG, Charley J. Radiological demarcation of cemented sockets in total hip replacement. Chin Orthop 1976;121:20-32.         [ Links ]

11. Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem type of loosening components: a radiographic analysis of loosening. Chin Orthop1979;141:17-27.         [ Links ]

12. Luck JV, Karpe EK. Surgical management of advanced haemophilic Arthropathy: an overview of 20 years experience. Chin Orthop 1989;242:60-82.         [ Links ]

13. Kesley SK, Jachiewicz PF, Gilbert MS, et al. Hip arthroplasty in haemophilic arthroplasty. Chin Orthop 1992;276:210.         [ Links ]

14. Lehman CR, Ries MD, Pairment GD, Davidson AB. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty 2001;16:330-5.         [ Links ]

15. Ragni MV, Crossett LS, Herndon JH. Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected haemophiliacs with CD4 count < 200/mm³. J Arthroplasty 1995;10.716-21.         [ Links ]

16. Haynes BF. Immune responses to human immunodeficiency virus infection. In AIDS: Etiology, Diagnosis, Treatment and Prevention, 1997; pp89-99 edited by VT De Vita Jr, S Hellman & S Rosenberg. Philadelphia: Lippincott - Raven.         [ Links ]

17. Goorney BP, Lacey H, Thuairajasingam S, Brown JDK. Avascular necrosis of the hip with HIV infection. Genitourim Med 1990;66:451-2.         [ Links ]

18. Kerruly JC, Chaisson RE, Moore RD. Increasing incidence of avascular necrosis of the hip in HIV infected patients. J Acquir Immune Def Syndr 2001;28:101-2.         [ Links ]

19. Bloom EJ, Abrams DI, Rodgers G. Lupus anticoagulant in the acquired immunodeficiency syndrome. JAMA 1986;265:491-93.         [ Links ]

20. Canoso RT, Zonli, Goofan JE. Anticardiolipin antibodies associated with HTLV-III infection. Bar's. Haematol 1987;65:495-98.         [ Links ]

21. Solomon G; Brancatol, Winchester R. An approach to human immunodeficiency virus positive patients with spondyloarthritic disease. Rheum Chin North Am 1991;17:43-58.         [ Links ]

22. Belmonte MA, Garcia-Partales R, Domenech I et al. Avascular necrosis of bone in human immunodeficiency virus infection and antiphospholipid antibodies. J Rheumatol 1993;20:1425-8.         [ Links ]

23. Rademaker J, Debro JS, Solomon G. Osteonecrosis and human immunodeficiency virus infection. J Rheumatol 197;24:601-4.         [ Links ]

24. Brown P, Crare L. Avascular necrosis of bone in patients with human immunodeficiency virus and osteonecrosis of the femoral head. J Arthroplasty 2002;17:135-9.         [ Links ]

25. Atahan A, Gatay A, Reyhan et al. Human immunodeficiency virus and avascular necrosis of femoral head; a case report. Chinese Med J 2004;117(9):1437-40.         [ Links ]

 

 

Reprint requests:
Dr S Brijlall
Tel: (031) 260-4293
Fax: (031) 260- 4518
Email: brij@netactive.co.za