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Operations about hip in human immunodeficiency virus-positive patients.

Yoo JJ, Chun SH, Kwon YS, Koo KH, Yoon KS, Kim HJ - Clin Orthop Surg (2010)

Bottom Line: 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.There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty.There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

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.

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Related in: MedlinePlus

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

Mentions: Of the three patients (six cases) with osteonecrosis of the femoral head, five cases were treated with hip replacement arthroplasty and one with multiple drilling. Two of them underwent a two of bilateral hip replacement procedures under spinal anesthesia with an interval of four months and two months respectively. The surgical time was 144, 144, 140, and 136 minutes, respectively. In the other patient, hip replacement arthroplasty was performed on one side and multiple drilling was performed on the other side simultaneously under spinal/epidural anesthesia for 275 minutes. Significant improvements in the Harris Hip Score and functional state were noted during 4, 6, and 28 month follow-up examination. There were no acute postoperative complications, such as infection, early loosening of implants, and dislocation. The one patient without preoperative anti-retroviral treatment was placed on anti-retroviral treatment postoperatively and the remaining four patients were on the anti-retroviral treatment that they had received preoperatively (Fig. 3). At the final follow-up, excluding the patient who died from esophageal variceal bleeding, the remaining four patients showed no complications associated with the orthopedic surgery.


Operations about hip in human immunodeficiency virus-positive patients.

Yoo JJ, Chun SH, Kwon YS, Koo KH, Yoon KS, Kim HJ - Clin Orthop Surg (2010)

Preoperative and postoperative X-ray of one osteonecrosis patient. The postoperative X-ray shows no evidence of complications, such as loosening or infection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2824091&req=5

Figure 3: Preoperative and postoperative X-ray of one osteonecrosis patient. The postoperative X-ray shows no evidence of complications, such as loosening or infection.
Mentions: Of the three patients (six cases) with osteonecrosis of the femoral head, five cases were treated with hip replacement arthroplasty and one with multiple drilling. Two of them underwent a two of bilateral hip replacement procedures under spinal anesthesia with an interval of four months and two months respectively. The surgical time was 144, 144, 140, and 136 minutes, respectively. In the other patient, hip replacement arthroplasty was performed on one side and multiple drilling was performed on the other side simultaneously under spinal/epidural anesthesia for 275 minutes. Significant improvements in the Harris Hip Score and functional state were noted during 4, 6, and 28 month follow-up examination. There were no acute postoperative complications, such as infection, early loosening of implants, and dislocation. The one patient without preoperative anti-retroviral treatment was placed on anti-retroviral treatment postoperatively and the remaining four patients were on the anti-retroviral treatment that they had received preoperatively (Fig. 3). At the final follow-up, excluding the patient who died from esophageal variceal bleeding, the remaining four patients showed no complications associated with the orthopedic surgery.

Bottom Line: 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.There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty.There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus