Human immunodeficiency virus in total hip arthroplasty

Abstract

Human immunodeficiency virus (HIV) is a pandemic affecting more than 35 million people worldwide. The aim of this review is to describe the association between HIV and total hip arthroplasty (THA) and assess patient risk factors to optimize functional outcomes and decrease rates of revision.Since the advent of highly active antiretroviral treatment (HAART), HIV-infected patients are living longer, which allows them to develop degenerative joint conditions. HIV and HAART act independently to increase the demand for THA. HIV-positive patients are also more predisposed to developing avascular necrosis (AVN) of the hip and femoral neck fractures due to decreased bone mineral density (BMD).Prior to the widespread implementation of access to HAART in homogenous cohorts of HIV-infected patients undergoing THA, reports indicated increased rates of complications. However, current literature describes equivocal functional outcomes and survival rates after THA in HIV-positive patients controlled on HAART when compared to HIV-negative controls.HIV-infected patients eligible for THA should be assessed for medical co-morbidities and serum markers of disease control should be optimized.Periprosthetic joint infection (PJI) is a leading cause of revision THA, and HIV is a modifiable risk factor. Importantly, the significance is negated once patients are placed on HAART and achieve viral suppression.THA should not be withheld in HIV-infected patients injudiciously. However, HIV is a burgeoning epidemic and all patients should be identified and started on HAART to avoid preventable peri-operative complications. Cite this article: EFORT Open Rev 2020;5:164-171. DOI: 10.1302/2058-5241.5.190030.

Keywords: human immunodeficiency virus; immunocompromise; total hip arthroplasty.

Fig. 1

Anteroposterior (AP) view of a 37-year-old HIV-infected male patient with a CD4+ of 438 cells/mm³ and an undetectable VL on HAART with bilateral femoral head AVN. Note. CD4+, CD4+ T-cell count; VL, viral load; HAART, highly active antiretroviral treatment; AVN, avascular necrosis.

Fig. 2

Anteroposterior (AP) view of a 69-year-old HIV-infected female patient with a CD4+ of 327 cells/mm³ and an undetectable VL on HAART with femoral neck fracture after a fall from standing height. The patient had chronic left hip pain for two years before this incident and the radiograph shows evidence of osteodegeneration with loss of joint space, osteophytosis and cysts in the femoral head. The right hip is pain free. Note. CD4+, CD4+ T-cell count; VL, viral load; HAART, highly active antiretroviral treatment.