Total knee arthroplasty in HIV‐positive haemophilic patients

Abstract

In the era of total joint replacements in orthopaedics, total knee arthroplasty (TKA) should be indicated in haemophilic patients suffering from severe knee pain and disability. However, the expected high risk of infection and other postoperative complications is a concern. Although the message of this article may seem conservative, it should not be inferred that TKA should still be avoided in a haemophilic patient, but rather that the orthopaedic surgeon should weigh the risks and benefits carefully. Clinical and immunological status should be considered before suggesting a total knee replacement to a haemophilic patient. If TKA is contraindicated, knee arthrodesis is the alternative. However, knee joint debridement can relieve pain for several years and delay the need for TKA.

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

“…Increased longevity, alongside rising rates of osteonecrosis and osteoarthritis, has resulted in a growing population of HIV-positive patients that are candidates for THA. Early studies reported high complication and revision rates for TJA performed in the HIV-positive population [18][19][20][21][22][23][24][25][26][27][28]. However, these early studies included predominantly hemophilic patients.…”

“…Historically, HIV has been considered an independent risk factor for poor outcomes following surgery, including orthopedic procedures [15][16][17]. Early studies in HIVpositive patients undergoing total joint arthroplasty (TJA) consistently reported higher rates of complications and early failures [18][19][20][21][22][23][24][25][26][27][28]. Authors warned of devastating complications such as deep tissue infection and hardware loosening, discouraging many patients from undergoing TJA [18][19][20][21][22][23][24][25][26][27][28].…”

Total joint arthroplasty in haemophilia

“…Thirteen of the joints had manipulation to improve range. Rodriguez-Merchan and Wiedel [18] in a retrospective study of 37 TKAs identi®ed that an MUA was less often required in those patients who had their TKA after 1986. Heeg et al [14] performed MUA due to limited range of motion postoperatively in two patients.…”

Joint Replacement in Patients with Hemophilia

“…Those patients at particular risk are the HIV-positive hemophilic patients whose CD4 count is <200 cells/mm 3 [11,12]. The pooled data suggest that total knee arthroplasty in hemophilic patients carries with it an increased risk of postoperative infection in comparison to nonhemophilic patients.…”