One-year follow-up of orthopaedic implants in HIV-positive patients

Abstract

We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. Of the 26 cases that were reviewed at 1 year, no late sepsis was identified. All of the fractures, non-unions, osteotomies and arthrodeses united. The literature indicates that late sepsis following arthroplasty occurs more frequently in haemophiliacs who are HIV positive than their HIV-negative counterparts. It is still not certain whether or not such a risk also applies to HIVpositive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.Résumé Nous avons suivi de façon prospective 38 implants orthopédiques chez 36 malades HIV-Positifs. La radiographie et l'examen clinique ont été utilisés pour étudier l'évolution et ont été recherchées les infections précoces et tardives survenant dans l'année suivant la chirurgie. Deux malades sont morts de causes sans rapport avec l'implantation, deux malades avaient des implants retirés pour des raisons autre qu'une infection, et huit cas ont été perdus de vue. Des 26 cas qui ont été examinés à une année, aucune infection tardive n'a été identifiée. Toutes les fractures, pseudarthroses, osteotomies et arthrodèses ont fusionnées. La littérature indique que les infections tardives après arthroplastie surviennent plus fréquemment chez les hémophiles séro-positifs que chez ceux qui sont séro-négatifs. Il n'est pas encore certain qu'un tel risque s'applique aussi à malades séropositifs qui ne sont pas des haemophiles. Cette étude augmente la confiance dans le fait que l'utilisation d'implants orthopédiques chez des patients immuno déprimés avec une peau intacte est sûre, au moins pour la période ou l'implant est nécessaire. Des études supplémentaires sont néces-saires pour savoir si les implants de fixation devraient être enlevés ou non.

Fracture healing in HIV-positive populations

“…Indeed, the screening of high-risk fracture patients for HIV has been advocated in order to tailor management. 17 This evidence therefore identifies an area in which emergency physicians and orthopaedic surgeons with limited knowledge of specialist HIV medicine could start to improve outcome significantly in this group of patients.…”

“…78 Furthermore, up to 71% of fractures from a similar group of patients were complicated by osteomyelitis. 17 These rates of infection are of great concern. In the context of a reduced BMD, a situation relevant to many HIV sero-positive patients, the use of internal fixation and particularly locking plates has been shown to give consistently good results.…”

“…1). 17 We present a review of this emerging issue, highlighting areas of clinical concern and propose a model with which to build clinical understanding in this field. Finally, avenues for new collaborative research are suggested.…”

Late implant sepsis after fracture surgery in HIV positive patients

“…Even this year, Randelli also called for removal of all implants in HIV positive patients [6]. However, a 1-year follow-up of 26 such cases by our own group identified no late implant sepsis [10].…”

Total hip replacement in patients with history of illicit injecting drug use

“…Looking to non-hemophilic HIV-positive patients, a higher rate of septic complications can yet not be concluded from the literature [12][13][14][15][16]. However, THA in hemophilic HIV seropositive patients is indeed associated with a high septic revision rate, which in Hicks's series [12] was as high as 18.7 % in primary and 36.4 % in revision THA's.…”