Total Hip Arthroplasty in HIV infected patients
Poster Presentation Number: P006
Location: San Diego Convention Center, Sails Pavilion
Adult Reconstruction Hip
Michael H Huo, MD Dallas TX (n)
John McGarry, MD Plano TX (n)
Evaluation of clinical and radiographic outcomes in a consecutive series of
primary THRs performed for osteonecrosis in HIV patients
Osteonecrosis(ON) of the femoral head has been recognized as a distinct entity
in patients infected with HIV. The incidence has been reported to be 0.3% to
0.5%. The purpose of this study was to evaluate the clinical and radiographic
outcome in a consecutive series of primary THRs performed for ON in HIV patients
23 patients underwent 31 THRs under one single surgeon over an 8-year period.
All patients were male. All contracted HIV through sexual contact. Risk factors
for ON included: protease inhibitors in 74%, hypercholesterolemia in 21.7%,
alcohol abuse in 13%, and steroid use in 8.7%. Ficat class included: II (10%),
III (45%), IV (45%). The mean age was 42 years (29-65). The mean BMI was 24
(18-29). The mean CD4 count was 377 (14-900), and viral load was 70 (0-126k). 3
patients (3 hips) were lost, and 4 patients (5 hips) had less than 2 years F/U.
The final analysis included 16 patients (23 hips). Mean F/U was 4.5 years
(2-9.5). The mean OR time was 156 minutes,EBL 330ml, and hospital stay 3.8 days.
3 patients died: 1 from AIDS at 10 months, 2 with unknown causes at 52 and 84
months respectively. Harris hip score was on average 43 preop, and 87 final.
Among the un-revised hips, 80% were rated good or excellent, and 20% fair or
poor. All surviving hips were judged to have stable fixation. There was no
infection, DVT, or dislocation. One patient had fever of unknown origin during
the hospital stay. 3 patients (4 hips) underwent revision of one or both
components. All were for aseptic loosening at 55 months (48-64). All 4 revised
stems were of identical design with matte-finish inserted with cement.
THR is safe and efficacious in this group of patients. We did not have any
infections, perhaps due to the relatively healthy status of these patients.
These were young and active patients. As patients with HIV are being managed
with improved medical therapy, they are expected to have near normal life
expectancy. It is therefore important to continue to monitor these patients
carefully for wear and loosening.
If noted, the author indicates something of value received:
a - Research or institutional support
b - Miscellaneous non-income support (e.g., equipment or services), commercially
derived honoraria, or other non-research related funding (e.g., paid travel)
c - Royalties have been received
d - Stock or stock options held
e - Consultant or employee
n - Nothing of value received
