Timing optimal pour l’arthroplastie totale de hanche programmée chez les patients HIV +

Abstract

IntroductionEvidence about the optimal timing for total hip replacement (THR) in HIV-positive patients is scant. HypothesisPreoperative criteria: cluster of differentiation 4(CD4)counts>200 cells/mm3 and an undetectable HIV virus load before THR, improve infection rates, aseptic loosenings, and functional outcomes. Materials and methodsWe recruited 16 HIV-positive patients who had undergone 25THRs between 2003 and 2015. None had hemophilia, and none were intravenous drug users (IVDUs). ResultsTheir mean age was 41.2years (range: 24–60); minimum follow-up was 12months (mean: 64.6); mean duration of prophylactic antibiotics was 2.9 days (range: 1–5); and mean hospital length of stay was 6.0 days (range: 4–11). No patients were treated with subsequent oral antibiotics. The mean preoperative CD4 count was 464.1±237.0 (range: 235–904) cells/mm3. There were no early superficial surgical site infections, late periprosthetic joint infections, or aseptic loosenings. Post-surgery Harris Hip score was significantly (p<0.001) better. DiscussionA preoperative CD4 count>200cell/mm3 and an undetectable HIV virus load might indicate optimal timing for elective THRs in HIV-positive patients without hemophilia and not IVDUs. Level of evidenceIV, retrospective or historical series.