Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3803-3809. doi: 10.1007/s00402-022-04586-z. Epub 2022 Sep 9.
Human immunodeficiency virus (HIV) positive patients are at high risk for osteonecrosis along with age-related osteoarthritis, resulting in a high number of joint reconstruction surgeries at younger ages in these immunosuppressed patients. Few previous studies have reported on patient outcomes in HAART (highly active antiretroviral therapy) compliant patients undergoing primary arthroplasty. The aim of this study is to report one institution's overall rate of complications and revision in HAART-compliant patients after primary hip and knee arthroplasty.
A retrospective chart review was performed spanning a 4 year period. This study included 50 primary joint arthroplasty patients diagnosed with HIV including 13 TKA (total knee arthroplasty) and 37 THA (total hip arthroplasty) with a prior diagnosis of HIV infection. Preoperative CD4 count and viral loads were recorded. Charts were reviewed for post-operative complications including infection and revision.
The were a total of 11 postoperative complications (22%). There were 3 cases (6%) of soft tissue infection, 3 cases (6%) of implant loosening, 2 cases (4%) of dislocation, 1 case (2%) of lower extremity weakness, 1 case (2%) of venous thrombosis, and 1 case (2%) of arthrofibrosis. Of all patients, there were 6 cases of revision in this cohort (12%), 5 of which were aseptic etiology. All 3 infected patients had a history of IVDU. Two of these infected patients resolved with IV antibiotics while 1 underwent two-stage revision (2%). Patients that experienced post-operative complications had significantly elevated preoperative CD4 levels (983 versus 598, p = 0.003).
Arthroplasty is a viable option for HAART-compliant patients. Most previous studies showing a higher risk for deep tissue infection and revision in HIV patients have not accounted for modern HAART. Our results show that compliance with HAART has vastly improved the outcomes of arthroplasty in these patients, while a history of IVDU is likely the largest risk factor for infection in this population.
人类免疫缺陷病毒（HIV）阳性患者存在骨坏死的高风险，同时还伴有与年龄相关的骨关节炎，导致这些免疫抑制患者在较年轻时进行大量关节重建手术。以前的几项研究报告了接受高效抗逆转录病毒治疗（HAART）的患者在初次关节置换术后的患者结局。本研究的目的是报告一家机构在接受 HAART 治疗的患者初次髋关节和膝关节置换术后的总体并发症和翻修率。
回顾性图表审查跨越了 4 年的时间。本研究包括 50 名 HIV 诊断的初次关节置换患者，包括 13 例全膝关节置换术（TKA）和 37 例全髋关节置换术（THA），均有 HIV 感染的既往诊断。记录术前 CD4 计数和病毒载量。对术后并发症进行评估，包括感染和翻修。
共有 11 例（22%）发生术后并发症。软组织感染 3 例（6%），假体松动 3 例（6%），脱位 2 例（4%），下肢无力 1 例（2%），静脉血栓形成 1 例（2%），关节僵硬 1 例（2%）。在所有患者中，该队列中有 6 例（12%）需要翻修，其中 5 例为无菌性病因。所有 3 例感染患者均有静脉药物使用史。其中 2 例感染患者经静脉抗生素治疗缓解，1 例患者接受了两阶段翻修（2%）。经历术后并发症的患者术前 CD4 水平显著升高（983 与 598，p=0.003）。
关节置换术是接受 HAART 治疗的患者的可行选择。以前的大多数研究表明，HIV 患者深部组织感染和翻修的风险更高，但没有考虑到现代 HAART。我们的结果表明，HAART 的依从性极大地改善了这些患者的关节置换术结局，而静脉药物使用史可能是该人群感染的最大风险因素。
