Fracture-related infections in HIV infected patients: A systematic review and meta-analysis

Nieuwoudt, Luan; Rodseth, Reitze; Marais, Leonard Charles

doi:10.1016/j.jor.2020.01.023

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…A recent meta-analysis looking at the risk of infection following fracture surgery noted that in the era of antiretroviral therapy, HIV-infected patients did not appear to have an elevated risk of fracture-related infection in open or closed fractures. 29 Aside from the risk of infection, there are concerns about several other complications related to arthroplasty in HIV-positive patients. There is data suggesting a greater tendency to thromboembolic phenomena in HIV-positive patients (two-to ten-fold increased risk), with patients younger than 50 years appearing to be particularly succeptible.…”

Section: Discussionmentioning

confidence: 99%

The association between HIV infection and periprosthetic joint infection following total hip replacement in young adults

Ngwazi

Ryan

Goga³

et al. 2021

SA orthop. j.

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BACKGROUND: The HIV burden in South Africa is high. HIV-positive patients are at risk of developing avascular necrosis of the femoral head, necessitating total hip arthroplasty (THA) at a relatively young age. The primary aim of this study was to investigate the relationship between HIV infection and the risk of periprosthetic joint infection (PJI) in young adults following total hip replacement. Secondly, we aimed to evaluate the association of HIV infection with venous thromboembolic events, reoperation and revision surgery METHODS: We undertook a retrospective cohort study involving patients under the age of 55 years who underwent THA between 2009 and 2016 at a tertiary level arthroplasty unit. In total, 290 cases in 213 patients were analysed, with 77 patients requiring bilateral THA. The median age of patients was 43 years (interquartile range [IQR] 39-48, range 26-54 years). Sixty-two per cent of patients were HIV positive (n=180) with a median CD4 count of 520 cells/mm3 (IQR 423-659, range 238-1308 cells/mm3). Seventy-eight per cent (n=141) of the HIV-positive patients were on antiretroviral medication before surgery. Almost all cases performed in the HIV-positive group were for avascular necrosis (n=178, 99% RESULTS: At a median follow-up of four years (range 2-10) there were no revisions in either group. The incidence of PJI was 1.1% in the HIV-positive group vs 0.9% in the HIV-negative group. The odds ratio for the development of PJI in HIV-positive patients was 1.22 (95% CI 0.11 to 13.67, p=0.869). There was no association between the CD4 count of HIV-positive patients and the development of PJI (p=0.171). There was no difference in the rate of venous thromboembolic events between the HIV-positive and HIV-negative groups (4% vs 6%, p=0.340 CONCLUSION: We report on a cohort of young adult patients who underwent THA. Patients living with HIV infection were not found to be at increased risk for PJI following THA, when compared to HIVnegative patients. The premise that HIV infection increases the risk for PJI following THA remains to be substantiated. This study was underpowered in terms of the primary outcome measure and larger studies are required to verify these findings Level of evidence: Level 4 Keywords: total hip arthroplasty, HIV, AIDS, avascular necrosis, hip, periprosthetic joint infection

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Section: Discussionmentioning

confidence: 99%

The association between HIV infection and periprosthetic joint infection following total hip replacement in young adults

Ngwazi

Ryan

Goga³

et al. 2021

SA orthop. j.

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“…A systematic review of FRI in HIV-positive patients found a non-significant increased risk overall for FRI in HIV-positive patients for operatively managed fractures (open and closed). Infection rates ranged from 3.1 to 100% in these 11 papers that cover the pre- and post-anti-retroviral era ( 22 ).…”

Section: Introduction and Aimsmentioning

confidence: 99%

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Tissingh

Marais

Loro³

et al. 2022

EFORT Open Reviews

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The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the diagnosis and management of FRI to low- and middle-income countries (LMICs); (ii) to summarise the available evidence on FRI, with consideration for strategies applicable to low resource settings. Data related to the International Consensus Meeting Orthopaedic Trauma Work Group and the International Fracture Related Infection Consensus Group FRI guidelines were collected including panel membership, country of origin, language of publication, open access status and impact factor of the journal of publication. The recommendations and guidelines were then summarised with specific consideration for relevance and applicability to LMICs. Barriers to implementation were explored within a group of LMIC residents and experienced workers. The authorship, evidence base and reach of the FRI consensus guidelines lack representation from low resource settings. The majority of authors (78.5–100%) are based in high-income countries and there are no low-income country collaborators listed in any of the papers. All papers are in English. The FRI consensus guidelines give a clear set of principles for the optimum management of FRI. Many of these – including the approach to diagnosis, multidisciplinary team working and some elements of surgical management – are achievable in low resource settings. Current evidence suggests that it is important that a core set of principles is prioritised but robust evidence for this is lacking. There are major organisational and infrastructure obstacles in LMICs that will make any standardisation of FRI diagnosis or management challenging. The detail of how FRI consensus principles should be applied in low resource settings requires further work. The important work presented in the current FRI consensus guidelines is relevant to low resource settings. However, leadership, collaboration, creativity and innovation will be needed to implement these strategies for communities who need it the most.

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“…These measures are justified since the risks include not only the fracture but also other potential underlying complications, and particularly infection. Although a consensus is well established, a recent meta-analysis regarding infection secondary to fracture treatment in HIV patients did not obtained significant results [ 10 ]. This excludes open fractures, where Aird et al .…”

Section: Discussionmentioning

confidence: 99%

“…Joint involvement may produce significant functional disability in these patients [ 4 ]. Fractures, frequently underdiagnosed if slowly developing, are usually managed through osteosynthesis [ 10–14 ]. However, late diagnosis may produce a more complex deformity and functional disability, and the management approach may vary.…”

Section: Introductionmentioning

confidence: 99%

Complications and surgical treatment after pathological fracture associated to HIV secondary disease. A case report

Fuentes-Sánchez

Gómez‐Barrena

2022

Journal of Surgical Case Reports

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Due to advances in retroviral treatment, human immunodeficiency virus (HIV)-related disease may become chronic and the patient survival has substantially increased. Osteoarticular disease in those patients include multifocal osteonecrosis and its complications. Pain and functional limitation may be due to these complications, frequently underdiagnosed, including pathological fractures. Its prompt management may require a different approach than osteosynthesis. We present a long-term chronic HIV patient with severe pain and limitation. A tibial plateau pathological fracture associated to multifocal osteonecrosis was identified and treated with osteonecrosis debridement and total knee arthroplasty (TKA). Acute periprosthetic joint infection developed and required debridement, antibiotic and implant retention. The contralateral knee, also with multiple osteonecrosis foci, was managed with early TKA. We highlight the importance of timely surgical reconstruction to avoid serious limitation and complications.

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Fracture-related infections in HIV infected patients: A systematic review and meta-analysis

Cited by 4 publications

References 20 publications

The association between HIV infection and periprosthetic joint infection following total hip replacement in young adults

The association between HIV infection and periprosthetic joint infection following total hip replacement in young adults

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Complications and surgical treatment after pathological fracture associated to HIV secondary disease. A case report

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