Outcomes of Total Hip Arthroplasty Performed for HIV-Associated Osteonecrosis in China: A Retrospective Cohort Study


Cite item

Full Text

Abstract

Background:In the post-epidemic era, Acquired Immune Deficiency Syndrome (AIDS) remains one of the most prevalent and detrimental infectious diseases worldwide. The incidence of osteonecrosis of the femoral head (ONFH) in AIDS patients is 100 times higher than that in healthy individuals. Although Total Hip Arthroplasty (THA) is ultimately necessary for most patients, there is still a dearth of evidence regarding its safety and efficacy in Chinese AIDS patients.

Methods:The clinical data of 49 patients who met the inclusion and exclusion criteria were retrospectively analyzed. Simultaneously, we categorized patients whose hemoglobin and albumin met a specific threshold as the optimized group and performed group comparisons.

Results:There are statistical differences in Harris score and VAS score pre- and post-operation, with a low overall complication rate. Notably, no disparities were observed between the optimized group and the partial optimized group in terms of overall conditions, laboratory examination indicators, severity of ONFH, surgical outcomes, surgical complications, pain perception or functional limitations. Furthermore, no correlation was found between CD4+ T lymphocytes and hemoglobin levels, albumin levels, white blood cell count, or platelet count.

Conclusion:THA is safe and effective in Chinese AIDS patients with ONFH. However, optimal treatment has limited efficacy in AIDS patients undergoing THA for ONFH. The reconsideration and evaluation of the predictive value of CD4+ T lymphocytes for postoperative complications in joint replacement procedures is warranted.

About the authors

Kangpeng Li

Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University

Email: info@benthamscience.net

Rui Ma

Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University

Email: info@benthamscience.net

Rugang Zhao

Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University

Email: info@benthamscience.net

Qiang Zhang

Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University

Author for correspondence.
Email: info@benthamscience.net

References

  1. Li K, Liu B, Ma R, Zhang Q. HIV tissue reservoirs: Current advances in research. AIDS Patient Care STDS 2023; 37(6): 284-96. doi: 10.1089/apc.2023.0028 PMID: 37184898
  2. Cribbs SK, Crothers K, Morris A. Pathogenesis of HIV-related lung disease: Immunity, infection, and inflammation. Physiol Rev 2020; 100(2): 603-32. doi: 10.1152/physrev.00039.2018 PMID: 31600121
  3. Lucas S, Nelson AM. HIV and the spectrum of human disease. J Pathol 2015; 235(2): 229-41. doi: 10.1002/path.4449 PMID: 25251832
  4. Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: The AGEhIV cohort study. Clin Infect Dis 2014; 59(12): 1787-97. doi: 10.1093/cid/ciu701 PMID: 25182245
  5. Bayard C, Ledergerber B, Flepp M, et al. Associations between antiretroviral treatment and avascular bone necrosis: The swiss HIV cohort study. Open Forum Infect Dis 2017; 4(4): ofx177. doi: 10.1093/ofid/ofx177 PMID: 29026869
  6. Zhao R, Ma R, Zhao C, Zhang Q. Risk factors for osteonecrosis of the femoral head in human immunodeficiency virus-positive patients: A retrospective case–control study. AIDS Res Hum Retroviruses 2022; 38(11): 869-74. doi: 10.1089/aid.2021.0224 PMID: 36166235
  7. Pepke W, Kasten P, Beckmann NA, Janicki P, Egermann M. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis: A randomized prospective study. Orthop Rev (Pavia) 2016; 8(1): 6162. doi: 10.4081/or.2016.6162 PMID: 27114808
  8. Jellis JE. Orthopaedic surgery and HIV disease in Africa. Int Orthop 1996; 20(4): 253-6. doi: 10.1007/s002640050074 PMID: 8872550
  9. Paiement GD, Hymes RA, LaDouceur MMS, Gosselin RA, Green HD. Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients. J Trauma 1994; 37(4): 545-51. doi: 10.1097/00005373-199410000-00005 PMID: 7932883
  10. Parvizi J, Sullivan TA, Pagnano MW, Trousdale RT, Bolander ME. Total joint arthroplasty in human immunodeficiency virus-positive patients: An alarming rate of early failure. J Arthroplasty 2003; 18(3): 259-64. doi: 10.1054/arth.2003.50094 PMID: 12728415
  11. Ares O, Arnold WV, Atilla B, et al. General Assembly, prevention, host related local: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34(2): S3-S12. doi: 10.1016/j.arth.2018.09.049 PMID: 30352771
  12. Yeramosu T, Chiang B, Barnes B, Satpathy J. Optimizing total joint arthroplasty for patients living with human immunodeficiency virus. Cureus 2022; 14(9): e28806. doi: 10.7759/cureus.28806 PMID: 36225481
  13. Enayatollahi MA, Murphy D, Maltenfort MG, Parvizi J. Human immunodeficiency virus and total joint arthroplasty: The risk for infection is reduced. J Arthroplasty 2016; 31(10): 2146-51. doi: 10.1016/j.arth.2016.02.058 PMID: 27131415
  14. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89(4): 780-5. doi: 10.2106/00004623-200704000-00012 PMID: 17403800
  15. Plate JF, Brown ML, Wohler AD, Seyler TM, Lang JE. Patient factors and cost associated with 90-day readmission following total hip arthroplasty. J Arthroplasty 2016; 31(1): 49-52. doi: 10.1016/j.arth.2015.07.030 PMID: 26278485
  16. Bolz NJ, Iorio R. Bundled payments: Our experience at an academic medical center. J Arthroplasty 2016; 31(5): 932-5. doi: 10.1016/j.arth.2016.01.055 PMID: 27020651
  17. Johns WL, Layon D, Golladay GJ, Kates SL, Scott M, Patel NK. Preoperative risk factor screening protocols in total joint arthroplasty: A systematic review. J Arthroplasty 2020; 35(11): 3353-63. doi: 10.1016/j.arth.2020.05.074 PMID: 32600816
  18. Gottschalk MB, Johnson JP, Sadlack CK, Mitchell PM. Decreased infection rates following total joint arthroplasty in a large county run teaching hospital: A single surgeon’s experience and possible solution. J Arthroplasty 2014; 29(8): 1610-6. doi: 10.1016/j.arth.2014.03.012 PMID: 24736290
  19. Nussenbaum FD, Rodriguez-Quintana D, Fish SM, Green DM, Cahill CW. Implementation of preoperative screening criteria lowers infection and complication rates following elective total hip arthroplasty and total knee arthroplasty in a veteran population. J Arthroplasty 2018; 33(1): 10-3. doi: 10.1016/j.arth.2017.07.031 PMID: 28838614
  20. Jacofsky D. The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients. Orthopedics 2013; 36(5): 378-9. doi: 10.3928/01477447-20130426-09 PMID: 23672896

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Bentham Science Publishers