Optimal timing for elective total hip replacement in HIV-positive patients - 29/06/18

Doi : 10.1016/j.otsr.2018.05.005

Chun-Hung Chang ^a, Shang-Wen Tsai ^a,^b, Cheng-Fong Chen ^a,^b, Po-Kuei Wu ^a,^b, Wing-Wai Wong ^c, Ming-Chau Chang ^a,^b, Wei-Ming Chen ^a,^b,^⁎
^a Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
^b Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
^c Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

^⁎Corresponding author at: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC.Department of Orthopedics and Traumatology, Taipei Veterans General Hospital201, Section 2, Shi-Pai RoadTaipei 112TaiwanROC

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Abstract

Introduction

Evidence about the optimal timing for total hip replacement (THR) in HIV-positive patients is scant.

Hypothesis

Preoperative criteria: cluster of differentiation 4 (CD4) counts>200cells/mm³ and an undetectable HIV virus load before THR, improve infection rates, aseptic loosenings, and functional outcomes.

Materials and methods

We recruited 16 HIV-positive patients who had undergone 25 THRs between 2003 and 2015. None had hemophilia, and none were intravenous drug users (IVDUs).

Results

Their mean age was 41.2 years (range: 24–60); minimum follow-up was 12 months (mean: 64.6); mean duration of prophylactic antibiotics was 2.9 days (range: 1–5); and mean hospital length of stay was 6.0 days (range: 4–11). No patients were treated with subsequent oral antibiotics. The mean preoperative CD4 count was 464.1±237.0 (range: 235–904)cells/mm³. There were no early superficial surgical site infections, late periprosthetic joint infections, or aseptic loosenings. Post-surgery Harris Hip score was significantly (p<0.001) better.

Discussion

A preoperative CD4 count>200cell/mm³ and an undetectable HIV virus load might indicate optimal timing for elective THRs in HIV-positive patients without hemophilia and not IVDUs.