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Scientific Articles   |    
Outcomes of Cementless Primary THA for Osteonecrosis in HIV-Infected Patients
Kimona Issa, MD1; Qais Naziri, MD1; Vijay Rasquinha, MD2; Aditya V. Maheshwari, MD2; Ronald E. Delanois, MD1; Michael A. Mont, MD1
1 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, Maryland 21215. E-mail address for M.A. Mont: mmont@lifebridgehealth.org
2 Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY 11203
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Investigation performed at the Rubin Institute for Advanced Orthopedics and SUNY Downstate Medical Center



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1845-1850. doi: 10.2106/JBJS.L.01583
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Abstract

Background: 

Symptomatic osteonecrosis of the joint is a frequent debilitating complication in patients who have been infected with the human immunodeficiency virus (HIV). In earlier reports, outcomes of primary total joint arthroplasty in such patients have been poor due to early failures, high infection rates, and increased complication rates. We report on the clinical and radiographic outcomes of primary total hip arthroplasty (THA) in nonhemophilic, HIV-infected patients as compared with the outcomes in a cohort of osteonecrosis patients who did not have this disease.

Methods: 

Thirty-four HIV-infected patients (forty-four hips) who underwent primary THA for the treatment of osteonecrosis during the period of 2001 through 2008 were compared with a control cohort of seventy patients (seventy-eight hips) who also underwent THA for the treatment of osteonecrosis but did not have HIV or other high-risk factors for revision. The patients in the HIV study group (eleven women and twenty-three men) had a mean age of forty-eight years (range, thirty-four to eighty years) and were followed for a mean of seven years (range, four to eleven years). Evaluated outcomes included implant survivorship, Harris hip score, infection rate, activity score, postoperative Short-Form 36 (SF-36) health survey score, and radiographic outcome.

Results: 

Kaplan-Meier survival analysis demonstrated no significant difference in aseptic implant survivorship between the HIV and comparison cohorts at the five-year (100% vs. 98%, respectively) and ten-year (95% vs. 96.5%, respectively) follow-up times. In addition, at the time of final follow-up, the mean postoperative Harris hip scores (85 points in the HIV group vs. 87 points in the comparison group), activity scores (5.7 points in the HIV group vs. 6.1 points in the comparison group), and SF-36 physical (43 points in the HIV group versus 46 points in the comparison group) and mental component summary scores (54 points in the HIV group versus 57 points in the comparison group) were statistically similar between the two cohorts. There were two late infections in the HIV cohort as compared with none in the comparison cohort.

Conclusions: 

Our results demonstrated excellent implant survivorship, clinical and radiographic outcomes, and minimal complications at the time of midterm follow-up in the HIV-infected patient group. We believe that the outcomes associated with primary THA are improving in this patient population as a result of better medical management; however, late infections are potential complications.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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