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

Abstract

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.

Validity of Total Hip Arthroplasty in Patients with Osteoarthritis

“…По формальным признакам эта операция сопоставима с ампутацией сегмента конечности и фактически является калечащей с той лишь разницей, что протез конечности можно заменять неограниченное число раз без вреда для пациента, а результаты реэндопротезирования гораздо хуже, чем при первичной замене сустава эндопротезом [22][23][24]. Помимо этого, ЭТБС, как и любая другая операция, может сопровождаться интра-или послеоперационными осложнениями вплоть до летального исхода [25][26][27]. Пациенты далеко не всегда соблюдают рекомендации врача по поводу ограничений движения в оперированном суставе и особого режима, что также ведет к разного рода осложнениям [4,28].…”