J oint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment.The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
With the introduction of readily available factor VIII and IX concentrates and programmes for home therapy and prophylaxis, most severe haemophilic arthropathies can be prevented. However, despite these programmes, bleeds into the ankle joints still occur during the years of growth. It is suggested that ankle haemarthroses may be caused by unrecognized inversion injuries by the patient. The history from a small child is not always accurate and when a child presents with a swollen ankle it is not uncommon for the medical team to make a diagnosis of haemarthrosis without really searching for the pathogenesis. This paper describes a clinical study using the 'Air-Stirrup'; (AS) ankle splint which is designed to restrict inversion. Children between the ages of 3 and 18 years with a history of recurrent ankle haemorrhages were entered into a 6-month trial. Results showed a positive reduction in the number of ankle haemorrhages experienced by the children.
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