Human Immunodeficiency Virus and Total Joint Arthroplasty: The Risk for Infection Is Reduced

Enayatollahi, Mohammad Ali; Murphy, Dominic F.; Maltenfort, Mitchell; Parvızı, Javad

doi:10.1016/j.arth.2016.02.058

Cited by 27 publications

(16 citation statements)

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“…Prior retrospective series in HIV+ patients undergoing total joint arthroplasty (TJA) reported infection rates of 10–15%; however, many of these reports included patients with additional risk factors for infection such as intravenous drug use and hemophilia and the studies were conducted prior to the era of widely available HAART [ 14 , 17 , 19 , 22 , 23 ]. More recent studies have suggested that infection rates may be much lower [ 20 ]. Enayatollahi et al performed a systematic review of 25 studies performed in the era of HAART therapy and analyzed a total of 722 TJA in HIV+ patients [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…More recent studies have suggested that infection rates may be much lower [ 20 ]. Enayatollahi et al performed a systematic review of 25 studies performed in the era of HAART therapy and analyzed a total of 722 TJA in HIV+ patients [ 20 ]. Issa et al performed a retrospective cohort comparison of patients undergoing THA for osteonecrosis with a 10-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…They found that HIV+ patients without hemophilia had an overall infection rate of 2.3% compared with 10% in those with hemophilia. Furthermore, the presence of HAART was associated with a significantly lower risk of infection [ 20 ]. Given the low prevalence of HIV infection in the United States (~0.9% in general population) and difficulty in developing a sizeable cohort in any single institution, Lin et al reported on the perioperative outcomes in THA using the National Inpatient Sample which represents a 20% sample of all inpatient admissions across the country [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these studies were limited by small sample size [ 11 ] or lack of clinical follow-up [ 12 , 18 ]. With the advent of newer, more effective HAART coupled with longer periods of medication adherence, the relationship between HIV and surgical site infection (SSI) is still unclear and can complicated by other viral infections or coexisting diseases [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

et al. 2020

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Background The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). Methods This study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period. Results Sixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection ( p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection. Conclusions Immunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

et al. 2020

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“…23 Recent studies have shown more promising results of TJA in the nonhemophiliac, non-intravenous drug user, HIVþ population. [23][24][25][26][27][28][29][30][31] Boylan, et al 24 found that although HIVþ patients are at an increased risk for perioperative wound infections, they are not at an elevated risk for overall complications. Falakassa et al 23 hypothesized that one change contributing to improvement in complications is that the incidence of hemophilia with HIV infection has gone down due to improvements in blood screening and recombinant factor.…”

Section: Discussion Total Knee Arthroplasty In Hivþ Patientsmentioning

confidence: 99%

Outcomes of Total Knee Arthroplasty in Human Immunodeficiency Virus-Positive Patients

et al. 2019

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AbstractSuccessful management of human immunodeficiency virus (HIV) has lengthened the life expectancy of HIV-positive (HIV + ) patients; consequently, increasing numbers of this patient population are candidates for total knee arthroplasty (TKA). This study seeks to provide detailed results of TKA in HIV+ patients and compare them to an HIV-negative (HIV − ) cohort. We performed a multicenter retrospective case–control study comparing 25 HIV+ patients to 25 HIV− patients undergoing TKA. The analysis included a cohort and subgroup stratification based on the presence or absence of postoperative complications. Prior to TKA, all 25 patients had a documented history of HIV infection. No intraoperative complications were reported. Ninety-day postoperative complications included knee contracture (one HIV + , no HIV − , p = 0.3124), periprosthetic joint infection requiring revision (one HIV + , no HIV − , p = 0.3124), mechanical fall requiring incision and drainage (one HIV + , no HIV − , p = 0.3124), and death (one HIV + , no HIV − , p = 0.3124). The average follow-up was 18.80 months. HIV+ patients stayed in the hospital for an average of 3.8 days following surgery, which was significantly greater than HIV− patients (2.28 days; p = 0.0040). As the life expectancy for HIV+ patients improves, a greater number will be TKA candidates. This study has shown an acceptable postoperative complication risk in an HIV+ patient population undergoing TKA, albeit with a significantly increased hospital length of stay.

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Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

Piuzzi,

Klika,

et al. 2023

Journal Orthopaedic Research

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Periprosthetic joint infection is a major complication of total joint arthroplasty. Even with current treatments, failure rates are unacceptably high with a 5‐year mortality rate of 26%. Majority of the literature in the field has focused on development of better biomarkers for diagnostics and treatment strategies including innovate antibiotic delivery systems, anti‐biofilm agents, and bacteriophages. Nevertheless, the role of the immune system, our first line of defense during PJI, is not well understood. Evidence of infection in PJI patients is found within circulation, synovial fluid, and tissue and include numerous cytokines, metabolites, antimicrobial peptides, and soluble receptors that are part of the PJI diagnosis workup. Macrophages, neutrophils, and myeloid derived suppressor cells (MDSCs) are initially recruited into the joint by chemokines and cytokines produced by immune cells and bacteria and are activated by pathogen‐associated molecular patterns (PAMPs). While these cells are efficient killers of planktonic bacteria by phagocytosis, opsonization, degranulation, and recruitment of adaptive immune cells, biofilm‐associated bacteria are troublesome. Biofilm is not only a physical barrier for the immune system but also elicit effector functions. Additionally, bacteria have developed mechanisms to evade the immune system by inactivating effector molecules, promoting killing or anti‐inflammatory effector cell phenotypes, and intracellular persistence and dissemination. Understanding these shortcomings and the mechanisms by which bacteria can subvert the immune system may open new approaches to better prepare our own immune system to combat PJI. Furthermore, preoperative immune system assessment and screening for dysregulation may aid in developing preventative interventions to decrease PJI incidence.This article is protected by copyright. All rights reserved.

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Human Immunodeficiency Virus and Total Joint Arthroplasty: The Risk for Infection Is Reduced

Cited by 27 publications

References 50 publications

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

Outcomes of Total Knee Arthroplasty in Human Immunodeficiency Virus-Positive Patients

Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

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