DENYING TOTAL HIP ARTHROPLASTY IN SMOKERS, PATIENTS WITH ALCOHOL ABUSE OR IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUSES. WHY?

Stanislav Bondarenko,Per Kjærsgaard-Andersen,Ahmed Badnaoui,Valentyna Maltseva

doi:10.15674/0030-5987202135-9

Stanislav Bondarenko, Per Kjærsgaard-Andersen + Show 2 more

Open Access

https://doi.org/10.15674/0030-5987202135-9

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Abstract

Nowadays total hip arthroplasty (THA) is one of the most successful surgical procedures in the world and the number of procedures performed is growing every year. However, its success largely depends on the absence of postoperative complications. Among the risk factors affecting the occurrence of postoperative complications are smoking, alcohol abuse, drug abuse, human immunodeficiency viruses (HIV), obesity, anemia, diabetes mellitus, malnutrition, rheumatoid arthritis, cardiovascular diseases, renal failure and dialysis, depression and anxiety. In the presented manuscript, such factors as HIV, smoking and alcohol abuse were considered. In smokers, bone regeneration slows down due to impaired bone metabolism and a slowdown in vascular recovery. Alcohol abuse affects human immunity, inhibiting T-helper cells, and also causing blood coagulation disorders. Alcohol abuse increases the risk of hospital complications, surgery related complications and general medical complications. Smoking can increase the risk of septiccomplications (lower respiratory tract infection, sepsis, urinary tract infection), myocardial infarction, risk of aseptic loosening of implants. Mortality was also higher in smokers compared to nonsmokers. HIV increases bone fragility, debilitation, rate of cardiovascular diseases and decreases the number of CD4+ cells in the blood, which directly affects the risk of periprosthetic joint infections and revision. All three factors increase the patient's lengthof stay in the hospital after THA. Currently, recommendations have been developed for preventive measures that need to be taken to reduce the risk of postoperative complications by performing primary THA. According to the recommendations, quitting smoking and drinking alcohol 4 weeks before THA will significantly reduce the risk of postoperative complications. For HIV-positive patients, antiretroviral therapy and subsequent assessing the viral load arerequired prior to THA. Preoperative care in this category of patients, undergoing primary THA, can reduce the risk of complications.

Highlights

Total hip arthroplasty (ТНА) is one of the most successful surgeries in the world
Tan et al [1] showed that drug abuse and human immunodeficiency viruses (HIV) are major risk factors of the occurrence of periprosthetic joint infection among 27,717 patients who underwent TKA or total hip arthroplasty (THA), while smoking takes the last place among the listed factors
Matharu et al [4] in a population-based cohort study of 60,812 THA in UK (12 % smokers, 33 % ex-smokers, 56 % non-smokers) showed that smoking increased the risk of lower respiratory tract infection and myocardial infarction (relative risk (RR) ratio = 0.65; 95 % CI = 0.61–0.69), as well as the use of opioid pain killers in the first year after

Summary

Introduction

Total hip arthroplasty (ТНА) is one of the most successful surgeries in the world. The number of THA conducted is growing every year, among other reasons this is due to the increase in life expectancy, especially in developed countries. Відмова від куріння та вживання алкоголю за 4 тижні до операції значно знизить ризик післяопераційних ускладнень.

Results

Conclusion