title: Knee and hip arthroplasty infection rates in persons with haemophilia: a 27 year single center experience during the HIV epidemic.
abstract: Total joint replacement (TJR) is an option for the management of chronic haemophilic arthropathy. Because surgery is technically challenging, there is a high rate of deep prosthetic infections, particularly in human immunodeficiency virus (HIV)-infected individuals. We determined the incidence of deep infection rates following total knee and hip arthroplasties in HIV-seropositive and HIV-seronegative persons with haemophilia. Fifty-one primary joint replacements were performed on 32 patients seen at a regional comprehensive haemophilia care center from 1975 to 2002. Thirty prostheses were placed in patients who were HIV-seropositive prior to surgery (n = 14) or seroconverted later (n = 16). Median age at the time of surgery was 33 years (range: 20-61) among 19 HIV-seropositive patients and 35 years (range: 26-74) among 13 HIV-negative patients. Median duration of follow-up was 83 months (range: 2-323). Rate of primary joint infection per artificial joint-year by HIV status was compared by Poisson regression. Main outcome measures were the incidence of primary replacement joint infections by HIV status. Deep infections developed in five (9.8%) of 51 replacement joints. There were two infections during 204.15 joint-years without HIV infection and three infections during 205.28 joint-years with HIV infection. The incidence rate of joint infection (0.98 vs. 1.46 per 100 joint-years) was not increased with HIV (relative risk, RR: 1.49, 95% CI: 0.25-8.93, P = 0.66). We conclude that HIV infection is not a contraindication to knee or hip replacement arthroplasty in the appropriate clinical setting.
authors.affiliation: Department of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Powell
authors.forename: C J
authors.initials: CJ
authors.lastname: Whitener
authors.forename: C E
authors.initials: CE
authors.lastname: Dye
authors.forename: J O
authors.initials: JO
authors.lastname: Ballard
authors.forename: M L
authors.initials: ML
authors.lastname: Shaffer
authors.forename: M E
authors.initials: ME
authors.lastname: Eyster
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004927:Escherichia coli Infections / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006679:HIV Seropositivity / Q000150:complications / Q000382:microbiology; D015497:HIV-1; D006395:Hemarthrosis / Q000209:etiology / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006621:Hip Joint / Q000382:microbiology; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D007719:Knee Joint / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome