Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUAN Yuping ¹ , XI Yinglong ¹ , CUN Xinhua ² , YANG Yi ¹ ,  LI Biao ¹ , ZHOU Junjie ¹ , TANG Xing ¹ , LI Zhenggang ¹

1. Department of Orthopaedics, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650000, P.R.China;
2. Department of Orthopaedics, Infectious Diseases Hospital of Yunnan Province, Kunming Yunnan, 650000, P.R.China;

Corresponding author：

LI Biao, Email: libiao0012010@163.com

Keywords：

Total hip arthroplasty; human immunodeficiency virus; avascular necrosis of the femoral head; cementless hip prosthesis

DOI：

10.7507/1002-1892.201806126

Video：

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Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups (P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups (P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group (t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups (P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation (P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Conclusion Cementless THA is a safe and effective method for ANFH in patients with HIV infection.

Citation： DUAN Yuping, XI Yinglong, CUN Xinhua, YANG Yi, LI Biao, ZHOU Junjie, TANG Xing, LI Zhenggang. Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1507-1511. doi: 10.7507/1002-1892.201806126 Copy

1.	Vallabha T, Dhamangaonkar M, Sindgikar V, et al. Clinical profile of surgical diseases with emergence of new problems in HIV+ individuals. Indian Journal of Surgery, 2017, 79(1): 29-32.
2.	Almeida AMR, Santos A. Nutritional status and CD4 cell counts in patients with HIV/AIDS receiving antiretroviral therapy//Health of HIV Infected People. Holland: Elsevier Inc, 2015: 243-252.
3.	Sighinolfi L, Carradori S, Chinelli F. Avascular necrosis of the femoral head: a side effect of highly active antiretroviral therapy (HAART) in HIV patients. Infection, 2000, 28(4): 254-255.
4.	Mary-Krause M, Billaud E, Poizot-Martin I, et al. Risk factors for osteonecrosis in HIV-infected patients: impact of treatment with combination antiretroviral therapy. AIDS, 2006, 20(12): 1627-1635.
5.	Molia AC, Strady C, Rouger C, et al. Osteonecrosis in six HIV-infected patients receiving highly active antiretroviral therapy. Ann Pharmacother, 2004, 38(12): 2050-2054.
6.	Monier P, McKown K, Bronze MS. Osteonecrosis complicating highly active antiretroviral therapy in patients infected with human immunodeficiency virus. Clin Infect Dis, 2000, 31(6): 1488-1492.
7.	Morse CG, Mican JM, Jones EC, et al. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis, 2007, 44(5): 739-748.
8.	Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9.	喻忠, 王黎明, 桂鉴超, 等. 全髋表面置换术治疗股骨头坏死. 中国骨伤, 2008, 21(1): 35-37.
10.	Parvizi J, Sullivan TA, Pagnano MW, et al. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty, 2003, 18(3): 259-264.
11.	Phaff M, Aird J, Rollinson PD. Delayed implants sepsis in HIV-positive patients following open fractures treated with orthopaedic implants. Injury, 2015, 46(4): 590-594.
12.	Lin CA, Kuo AC, Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg (Am), 2013, 95(11): 1028-1036.
13.	Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep, 2014, 63(RR-03): 1-11.
14.	Hicks JL, Ribbans WJ, Buzzard B, et al. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg (Br), 2001, 83(7): 1050-1054.
15.	Lehman CR, Ries MD, Paiement GD, et al. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty, 2001, 16(3): 330-335.
16.	Li X, Xue Y, Zhou L, et al. Evidence that HIV-1 CRF01_AE is associated with low CD4+T cell count and CXCR4 co-receptor usage in recently infected young men who have sex with men (MSM) in Shanghai, China. PLoS One, 2014, 9(2): e89462.
17.	Chokotho L, Harrison WJ, Lubega N, et al. Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment. Malawi Med J, 2013, 25(2): 28-32.
18.	Guild GN, Moore TJ, Barnes W, et al. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res, 2012, 470(5): 1507-1512.
19.	Yang H, Li X, Stanton B, et al. HIV-related knowledge, stigma, and willingness to disclose: A meditation analysis. AIDS Care, 2006, 18(7): 717-724.
20.	Paxton S. The paradox of public HIV disclosure. AIDS Care, 2002, 14(4): 559-567.
21.	Bahebeck J, Eone DH, Nonga BN, et al. Implant orthopaedic surgery in HIV asymptomatic carriers: management and early outcome. Injury, 2009, 40(11): 1147-1150.
22.	李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
23.	虞连奎, 戚超, 于腾波, 等. 骨水泥与非骨水泥型人工全髋关节置换治疗肾移植术后股骨头缺血性坏死的近期疗效比较. 中国修复重建外科杂志, 2013, 27(12): 1409-1413.
24.	Hoess A, López A, Engqvist H, et al. Comparison of a quasi-dynamic and a static extraction method for the cytotoxic evaluation of acrylic bone cements. Mater Sci Eng C Mater Biol Appl, 2016, 62: 274-282.
25.	赵云宏, 杨毅, 李彪, 等. 生物型人工全髋关节置换术治疗 Crowe Ⅲ型成人髋关节发育不良的疗效观察. 中国修复重建外科杂志, 2016, 30(8): 947-950.
26.	Lemaire R, Masson JB. Risk of transmission of blood-borne viral infection in orthopaedic and trauma surgery. J Bone Joint Surg (Br), 2000, 82(3): 313-23.
27.	刘保池, 李垒, 刘立, 等. HIV 感染者围手术期治疗. 中国艾滋病性病, 2010, 16(5): 453-455.

1. Vallabha T, Dhamangaonkar M, Sindgikar V, et al. Clinical profile of surgical diseases with emergence of new problems in HIV+ individuals. Indian Journal of Surgery, 2017, 79(1): 29-32.
2. Almeida AMR, Santos A. Nutritional status and CD4 cell counts in patients with HIV/AIDS receiving antiretroviral therapy//Health of HIV Infected People. Holland: Elsevier Inc, 2015: 243-252.
3. Sighinolfi L, Carradori S, Chinelli F. Avascular necrosis of the femoral head: a side effect of highly active antiretroviral therapy (HAART) in HIV patients. Infection, 2000, 28(4): 254-255.
4. Mary-Krause M, Billaud E, Poizot-Martin I, et al. Risk factors for osteonecrosis in HIV-infected patients: impact of treatment with combination antiretroviral therapy. AIDS, 2006, 20(12): 1627-1635.
5. Molia AC, Strady C, Rouger C, et al. Osteonecrosis in six HIV-infected patients receiving highly active antiretroviral therapy. Ann Pharmacother, 2004, 38(12): 2050-2054.
6. Monier P, McKown K, Bronze MS. Osteonecrosis complicating highly active antiretroviral therapy in patients infected with human immunodeficiency virus. Clin Infect Dis, 2000, 31(6): 1488-1492.
7. Morse CG, Mican JM, Jones EC, et al. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis, 2007, 44(5): 739-748.
8. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9. 喻忠, 王黎明, 桂鉴超, 等. 全髋表面置换术治疗股骨头坏死. 中国骨伤, 2008, 21(1): 35-37.
10. Parvizi J, Sullivan TA, Pagnano MW, et al. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty, 2003, 18(3): 259-264.
11. Phaff M, Aird J, Rollinson PD. Delayed implants sepsis in HIV-positive patients following open fractures treated with orthopaedic implants. Injury, 2015, 46(4): 590-594.
12. Lin CA, Kuo AC, Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg (Am), 2013, 95(11): 1028-1036.
13. Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep, 2014, 63(RR-03): 1-11.
14. Hicks JL, Ribbans WJ, Buzzard B, et al. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg (Br), 2001, 83(7): 1050-1054.
15. Lehman CR, Ries MD, Paiement GD, et al. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty, 2001, 16(3): 330-335.
16. Li X, Xue Y, Zhou L, et al. Evidence that HIV-1 CRF01_AE is associated with low CD4+T cell count and CXCR4 co-receptor usage in recently infected young men who have sex with men (MSM) in Shanghai, China. PLoS One, 2014, 9(2): e89462.
17. Chokotho L, Harrison WJ, Lubega N, et al. Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment. Malawi Med J, 2013, 25(2): 28-32.
18. Guild GN, Moore TJ, Barnes W, et al. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res, 2012, 470(5): 1507-1512.
19. Yang H, Li X, Stanton B, et al. HIV-related knowledge, stigma, and willingness to disclose: A meditation analysis. AIDS Care, 2006, 18(7): 717-724.
20. Paxton S. The paradox of public HIV disclosure. AIDS Care, 2002, 14(4): 559-567.
21. Bahebeck J, Eone DH, Nonga BN, et al. Implant orthopaedic surgery in HIV asymptomatic carriers: management and early outcome. Injury, 2009, 40(11): 1147-1150.
22. 李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
23. 虞连奎, 戚超, 于腾波, 等. 骨水泥与非骨水泥型人工全髋关节置换治疗肾移植术后股骨头缺血性坏死的近期疗效比较. 中国修复重建外科杂志, 2013, 27(12): 1409-1413.
24. Hoess A, López A, Engqvist H, et al. Comparison of a quasi-dynamic and a static extraction method for the cytotoxic evaluation of acrylic bone cements. Mater Sci Eng C Mater Biol Appl, 2016, 62: 274-282.
25. 赵云宏, 杨毅, 李彪, 等. 生物型人工全髋关节置换术治疗 Crowe Ⅲ型成人髋关节发育不良的疗效观察. 中国修复重建外科杂志, 2016, 30(8): 947-950.
26. Lemaire R, Masson JB. Risk of transmission of blood-borne viral infection in orthopaedic and trauma surgery. J Bone Joint Surg (Br), 2000, 82(3): 313-23.
27. 刘保池, 李垒, 刘立, 等. HIV 感染者围手术期治疗. 中国艾滋病性病, 2010, 16(5): 453-455.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty

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