Special Issues Involving Periprosthetic Infection in Immunodeficiency Patients

Abstract

Chronic systemic illnesses such as diabetes mellitus, chronic kidney disease (CKD), liver cirrhosis, neoplasia, etc. have been clearly associated with high rates of SWI. However, the exact mechanisms underlying these observations are still under investigation.Chronic kidney disease (CKD) is a growing problem in our society. Many of these patients will require an arthroplasty and it appears that the prosthetic infection risk for these types of patients is much higher than in the normal population. The risk of complications due to infection seems to be lower in patients with kidney transplants than in patients undergoing haemodialysis. Both prophylaxis and treatment of infection in patients with CKD should be carried out with a strict monitoring of potentially nephrotoxic antibiotics.The literature on the prognosis and risk of infection in patients with haematopoietic stem cell transplant is scarce and occasionally contradictory. The optimal time for the surgery should be determined by taking into account the immunological state of the patient and should be avoided, as much as possible, during the first year after the HSCT.Child’s classification system is the most widely used method of stratifying the surgical risk for patients with cirrhosis; the infection appeared to be associated in a statistically significant way with advanced age and a Child B pre-operative classification.The prevention of prosthetic joint infections in HIV-infected patients should not be significantly different from the prevention for any other patient. Those patients that receive adequate antiretroviral treatment and periodic laboratory control show infection rates and periprosthetic complications that are similar to those for patients not affected by HIV. Therefore, the patient’s level of immunodeficiency is the most important prognostic factor for prosthetic infection.The particular immunological condition of these patients can lead to infections due to particular microorganisms that immunocompetent patients do not have to deal with. Of all possibilities, because of their frequency and difficulty to treat, infections caused by methicillin-resistant S. aureus and fungus are highlighted.

What Risks are Associated with Primary THA in Recipients of Hematopoietic Stem Cell Transplantation?

“…Among the risks of degenerative joint disease that increases with age, the increased risk of AVN from immunosuppressive medications and/or graft versus host disease, and the growing number of patients undergoing stem-cell transplantation, it seems likely that the number of such patients undergoing elective THA will increase. However, with a high incidence of medical comorbidities, immunosuppressive regimens, and often diminished numbers of circulating hematopoietic cell lines, these patients undergoing THA are at a potentially greater risk for perioperative complications [2,11,12]. We sought to determine the mortality, complications, and implant survivorship in this difficult-to-treat cohort undergoing THA at our institution.…”

“…With multiple medical comorbidities, immunosuppressive therapy regimens, and frequently diminished levels of erythrocytes, leukocytes, and platelets, patients receiving hematopoietic stem cell transplantation can be at increased risk of perioperative medical and surgical complications, including deep periprosthetic joint infection [11,12]. Historical studies have shown a high risk of complications and infections in such patients undergoing surgical reconstruction of proximal femoral pathologic fractures [2,4,9,12].…”

La prothèse de hanche infectée : le point de vue du médecin

“…La présence d'une pathologie chronique déséquilibrée : Cirrhose Child B ou C, Immunodépression (transplantation d'organe, corticothérapie systémique > 10 mg/j ou maladie VIH non contrôlée définie par un taux de CD4 < 400/mm 3 et/ou une charge virale détectable > 50 copies/mL) [14] augmente significativement le risque infectieux péri-opératoire et contre-indique temporairement la chirurgie. Cette pathologie doit être prise en charge prioritairement avant de reconsidérer la mise en place de la PTH [15].…”

Cultura dos tecidos profundos na artroplastia total primária do quadril: valor prognóstico para infecção periprotética

“…Devido ao sucesso da terapia antirretroviral, ainda existe controvérsia sobre a associação entre a infecção pelo HIV (vírus da imunodeficiência humana) e risco de IPP [54][55][56][57] 54,57 .…”