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DOI: 10.1055/s-0042-1750050
Impact of Human Immunodeficiency Virus on Postoperative Outcomes following Osteonecrosis-Indicated Total Hip Arthroplasty
Abstract
Osteonecrosis (ON) of the femoral head in human immunodeficiency virus (HIV)-positive patients is often treated with total hip arthroplasty (THA). The purpose of this study was to determine the effect that HIV positive status and acquired immunodeficiency syndrome (AIDS) have on postoperative complication rates and outcomes in patients with ON treated with THA. Patients who underwent primary ON-indicated THA with a minimum of 2-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those who were HIV-positive and those who were HIV-negative (control). The HIV-positive cohort was further stratified into those with AIDS and those with asymptomatic HIV at the time of THA. Univariate and multivariate analyses were conducted to determine associations between the three cohorts and their 90-day, and 2-year outcomes were each compared with HIV-negative patients. In this study, 1,163 patients were in the HIV-positive cohort and 34,288 were in the HIV-negative cohort. In the HIV-positive cohort, there were significantly higher 90-day rates of renal failure (odds ratio [OR] = 1.874; p < 0.001), pneumonia (OR = 1.682; p = 0.002), and sepsis (OR = 1.975; p < 0.001). The asymptomatic HIV cohort and AIDS cohort followed similar associations as the HIV cohort; however, the AIDS cohort also had significantly higher rate of blood transfusion (OR = 1.692; p = 0.012) and deep vein thrombosis (OR = 1.765; p = 0.036). HIV infection, whether symptomatic or not, and AIDS are associated with a higher risk of short-term complications after THA. Physicians must consider this risk and discuss with their patients to reduce future complications.
Keywords
human immunodeficiency virus - osteonecrosis - avascular necrosis - total hip arthroplasty - postoperative outcomes - complication ratesDeclaration
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Publication History
Received: 19 October 2021
Accepted: 02 May 2022
Article published online:
12 July 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Lespasio MJ, Sodhi N, Mont MA. Osteonecrosis of the hip: a primer. Perm J 2019; 23: 18-100
- 2 Cabrita HA, Santos AL, Gobbi RG. et al. Avascular necrosis of the femoral head in HIV-infected patients: preliminary results from surgical treatment for ceramic-ceramic joint replacement. Rev Bras Ortop 2015; 47 (05) 626-630
- 3 Matos MA, Alencar RW, Matos SS. Avascular necrosis of the femoral head in HIV infected patients. Braz J Infect Dis 2007; 11 (01) 31-34
- 4 Chokotho L, Harrison WJ, Lubega N, Mkandawire NC. Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment. Malawi Med J 2013; 25 (02) 28-32
- 5 Johns DG, Gill MJ. Avascular necrosis in HIV infection. AIDS 1999; 13 (14) 1997-1998
- 6 Pietrzak JRT, Maharaj Z, Mokete L, Sikhauli N. Human immunodeficiency virus in total hip arthroplasty. EFORT Open Rev 2020; 5 (03) 164-171
- 7 UNAIDS factsheet, June 2020. https://www.aidsinfo.unaids.org. Accessed May 15, 2022
- 8 Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015; 6 (08) 590-601
- 9 Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 1992; 326 (22) 1473-1479
- 10 Morse CG, Mican JM, Jones EC. et al. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis 2007; 44 (05) 739-748
- 11 Gutiérrez F, Padilla S, Masiá M. et al; HIV-related Osteonecrosis Study Group. Osteonecrosis in patients infected with HIV: clinical epidemiology and natural history in a large case series from Spain. J Acquir Immune Defic Syndr 2006; 42 (03) 286-292 DOI: 10.1097/01.qai.0000225012.53568.20. [published correction appears in J Acquir Immune Defic Syndr. 2006 Aug 15;42(5):650]
- 12 Tornero E, García S, Larrousse M. et al. Total hip arthroplasty in HIV-infected patients: a retrospective, controlled study. HIV Med 2012; 13 (10) 623-629
- 13 Mahoney CR, Glesby MJ, DiCarlo EF, Peterson MG, Bostrom MP. Total hip arthroplasty in patients with human immunodeficiency virus infection: pathologic findings and surgical outcomes. Acta Orthop 2005; 76 (02) 198-203
- 14 Lehman CR, Ries MD, Paiement GD, Davidson AB. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty 2001; 16 (03) 330-335
- 15 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 (03) 259-264
- 16 Ries MD, Barcohana B, Davidson A, Jergesen HE, Paiement GD. Association between human immunodeficiency virus and osteonecrosis of the femoral head. J Arthroplasty 2002; 17 (02) 135-139
- 17 Miller KD, Masur H, Jones EC. et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 2002; 137 (01) 17-25
- 18 Zhao CS, Li X, Zhang Q, Sun S, Zhao RG, Cai J. Early outcomes of primary total HIP arthroplasty for osteonecrosis of the femoral head in patients with human immunodeficiency virus in China. Chin Med J (Engl) 2015; 128 (15) 2059-2064
- 19 Falakassa J, Diaz A, Schneiderbauer M. Outcomes of total joint arthroplasty in HIV patients. Iowa Orthop J 2014; 34: 102-106
- 20 Dimitriou D, Ramokgopa M, Pietrzak JRT, van der Jagt D, Mokete L. Human immunodeficiency virus infection and hip and knee arthroplasty. JBJS Rev 2017; 5 (09) e8 DOI: 10.2106/JBJS.RVW.17.00029. [published correction appears in JBJS Rev. 2019 Nov;7(11):e7]
- 21 Issa K, Naziri Q, Rasquinha V, Maheshwari AV, Delanois RE, Mont MA. Outcomes of cementless primary THA for osteonecrosis in HIV-infected patients. J Bone Joint Surg Am 2013; 95 (20) 1845-1850
- 22 Lin CA, Takemoto S, Kandemir U, Kuo AC. Mid-term outcomes in HIV-positive patients after primary total hip or knee arthroplasty. J Arthroplasty 2014; 29 (02) 277-282
- 23 Inabathula A, Dilley JE, Ziemba-Davis M. et al. Extended oral antibiotic prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am 2018; 100 (24) 2103-2109
- 24 Shen YM, Frenkel EP. Thrombosis and a hypercoagulable state in HIV-infected patients. Clin Appl Thromb Hemost 2004; 10 (03) 277-280
- 25 Saber AA, Aboolian A, LaRaja RD, Baron H, Hanna K. HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement. Am Surg 2001; 67 (07) 645-647
- 26 Evans RH, Scadden DT. Haematological aspects of HIV infection. Best Pract Res Clin Haematol 2000; 13 (02) 215-230
- 27 van den Berg K, van Hasselt J, Bloch E. et al. A review of the use of blood and blood products in HIV-infected patients. South Afr J HIV Med 2012; 13 (02) 87-104
- 28 Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 2014; 96 (23) 1945-1951
- 29 Fillingham YA, Ramkumar DB, Jevsevar DS. et al. The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplasty 2018; 33 (10) 3083-3089 .e4
- 30 Xu H, Xie J, Lei Y, Huang Q, Huang Z, Pei F. Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. J Orthop Surg Res 2019; 14 (01) 163 DOI: 10.1186/s13018-019-1211-0.
- 31 Graham SM, Howard N, Moffat C, Lubega N, Mkandawire N, Harrison WJ. Total hip arthroplasty in a low-income country: ten-year outcomes from the National Joint Registry of the Malawi Orthopaedic Association. JBJS Open Access 2019; 4 (04) e0027.1-5