Clin Orthop Surg.  2010 Mar;2(1):22-27. 10.4055/cios.2010.2.1.22.

Operations about Hip in Human Immunodeficiency Virus-Positive Patients

• Yoo JJ
• Chun SH
• Kwon YS
• Koo KH
• Yoon KS
• Kim HJ

• KMID: 1110345
• DOI: http://doi.org/10.4055/cios.2010.2.1.22

Abstract

BACKGROUND: The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.
METHODS
This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).
RESULTS
The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.
CONCLUSIONS
There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.

Keyword

Human immunodeficiency virus; Acquired immunodeficiency syndrome; Operation; Hip joint; Complication

MeSH Terms

Adult
*Arthroplasty, Replacement, Hip/adverse effects
Bone Transplantation
CD4 Lymphocyte Count
Femoral Fractures/complications/*surgery
Femur Head Necrosis/complications/*surgery
Fractures, Ununited/complications/*surgery
HIV Infections/*complications/immunology/transmission/virology
Humans
Infectious Disease Transmission, Patient-to-Professional/prevention & control
Male
Middle Aged
Postoperative Complications
Viral Load
Young Adult

Figure

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  Fig. 1 Preparation of the operating room and operator. All preparations were carried out according to the guidelines of HIV infection control set by the Korea Centers for Disease Control and Prevention.

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  Fig. 2 Preoperative and postoperative X-ray of one nonunion patient. The postoperative X-ray shows that a callus had formed and union was achieved.

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  Fig. 3 Preoperative and postoperative X-ray of one osteonecrosis patient. The postoperative X-ray shows no evidence of complications, such as loosening or infection.

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