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Case Reports
. 2022 Jun 10;2022(6):rjac223.
doi: 10.1093/jscr/rjac223. eCollection 2022 Jun.

Complications and surgical treatment after pathological fracture associated to HIV secondary disease. A case report

Jorge Fuentes-Sánchez  1 , Enrique Gómez-Barrena  2
Affiliations
Case Reports

Complications and surgical treatment after pathological fracture associated to HIV secondary disease. A case report

Jorge Fuentes-Sánchez et al. J Surg Case Rep. .

Abstract

Due to advances in retroviral treatment, human immunodeficiency virus (HIV)-related disease may become chronic and the patient survival has substantially increased. Osteoarticular disease in those patients include multifocal osteonecrosis and its complications. Pain and functional limitation may be due to these complications, frequently underdiagnosed, including pathological fractures. Its prompt management may require a different approach than osteosynthesis. We present a long-term chronic HIV patient with severe pain and limitation. A tibial plateau pathological fracture associated to multifocal osteonecrosis was identified and treated with osteonecrosis debridement and total knee arthroplasty (TKA). Acute periprosthetic joint infection developed and required debridement, antibiotic and implant retention. The contralateral knee, also with multiple osteonecrosis foci, was managed with early TKA. We highlight the importance of timely surgical reconstruction to avoid serious limitation and complications.

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Figures

Figure 1
Figure 1
Initial both-legs standing radiographs of the knee. It showed a pattern of diffuse osteopenia with areas of sclerosis, lateral extended bone reaction and decreased lateral articular space (Kellgren–Lawrence 3) in the left knee. Bone necrosis with decreased medial articular space (Kellgren–Lawrence 3) were observed in the right knee.
Figure 2
Figure 2
Standing X-rays of the left knee 8 months later showed collapse with depression of the external tibial plateau and associated bone defect that caused 28° valgus deformity.
Figure 3
Figure 3
Surgical photograph showing the large bone defect.
Figure 4
Figure 4
X-ray of the left knee showing reconstruction with 10-mm tibial lateral block and a tibial diaphyseal stem.
Figure 5
Figure 5
Pathological sample 1: bone marrow fibrosis on the left and osteolysis with empty lacunae enlarged in perimeter without osteocytes on the right.
Figure 6
Figure 6
Pathological sample 2: hypertrophic chronic synovitis, without signs of acute inflammation, evidencing a long evolution of the process.
Figure 7
Figure 7
Evolution of the right knee by standing radiographs during follow-up with progression toward joint space disappearance (Kellgren–Lawrence 4) in a severe varus deformity.
Figure 8
Figure 8
Surgical photograph showing the large bone defect in the right knee especially in the femoral condyles.
Figure 9
Figure 9
Both knees standing radiographs at 4-year follow-up with no signs of radiological loosening.
See this image and copyright information in PMC

References

    1. Borderi M, Gibellini D, Vescini F, De Crignis E, Cimatti L, Biagetti C, et al. Metabolic bone disease in HIV infection. AIDS 2009;23:1297–310. - PubMed
    1. Musculoskeletal disorders in HIV-infected patients. National AIDS plan (PNS) and the AIDS study group (GESIDA). Enferm Infecc Microbiol Clin 2011;29:515–23. - PubMed
    1. Tehranzadeh J, Ter-Oganesyan RR, Steinbach LS. Musculoskeletal disorders associated with HIV infection and AIDS. Part I: infectious musculoskeletal conditions. Skeletal Radiol 2004;33:249–59. - PubMed
    1. Dimitriou D, Ramokgopa M, Pietrzak JRT, van der Jagt D, Mokete L. Human immunodeficiency virus infection and hip and knee arthroplasty. JBJS Rev 2017;5:e8. - PubMed
    1. Falakassa J, Diaz A, Schneiderbauer M. Outcomes of total joint arthroplasty in HIV patients. Iowa Orthop J 2014;34:102–6. - PMC - PubMed

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