Abstract
Background
The prevalence of immunocompromised patients undergoing Total Hip Arthroplasty (THA) is increasing worldwide as a consequence of advances in treatment. HIV is presenting in an older population group and concerns of higher rates of infection, early failures and dangers posed to healthcare workers exist. This study is imperative to predict future burden of THA and make subsequent provisions
Objectives
The objective was to determine the seroprevalence of HIV in patients presenting for THA in an academic institution in a developing country. Secondarily, the aim was to determine if there is any difference in the seroprevalence of patients undergoing THA and TKA and finally to assess the status of disease control in seropositive patients eligible for TJA on pre-existing HAART.
Study Design & Methods
The seroprevalence of HIV in 676 non-haemophilic patients undergoing Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) at a single academic institution was prospectively assessed. All patients undergoing TJA from January 2016 – March 2018 were counselled and offered HIV testing pre-operatively. HIV ELISA tests were performed on all consenting patients awaiting TJA. The CD4+ count and viral load was measured for all HIV-infected patients. Viral load is a strong indicator of good viral suppression and is a positive prognostic factor for the long-term disease outcome
Results
There were 51 patients (14.4%) of 352 patients undergoing THA who were HIV-infected. The seroprevalence of 324 patients undergoing TKA was 5.86%. There were 56 patients (8.2%) who refused HIV testing. Young females (<45 years old) were 6.8 times more likely to refuse testing. Overall, 70 patients (10.3%) of awaiting TJA were HIV-positive Only 14 patients (2%) undergoing TJA were newly diagnosed with HIV-infection. All other patients were already on anti-retroviral therapy. The age of HIV-infected patients awaiting THA (54.56 years) was statistically significantly (p=0.036) younger than patients awaiting TKA (62.45 years). The Body Mass Index (BMI) was significantly lower in THA than TKA (p=0.021). The average CD4+ counts for THA and TKA was 286 (56–854) and 326 (185–1000) respectively. 67% of patients had a viral load less than lower than detectable level (LDL). Of the HIV-infected patients presenting for THA, 34 (67%) had evidence of avascular necrosis (AVN) and 4 (7.84%) with a neck of femur fracture. No HIV-infected patients presenting for TKA had evidence of AVN of the knee.
Conclusions
The seroprevalence of HIV in patients undergoing THA is higher than those undergoing TKA and the reported average in the general population. This may reflect the high association between both HIV and HAART and AVN of the hip. Our findings predict a significant burden on arthroplasty services in the future
