Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty
Abstract Background The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of...
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01827-y |
| _version_ | 1798039292233121792 |
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| author | Carol A. Lin Phillip H. Behrens Guy Paiement W. David Hardy James Mirocha Robert L. Rettig Heidi L. Kiziah Andrew G. Rudikoff Antonio Hernandez Conte |
| author_facet | Carol A. Lin Phillip H. Behrens Guy Paiement W. David Hardy James Mirocha Robert L. Rettig Heidi L. Kiziah Andrew G. Rudikoff Antonio Hernandez Conte |
| author_sort | Carol A. Lin |
| collection | DOAJ |
| description | Abstract Background The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). Methods This study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period. Results Sixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection (p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection. Conclusions Immunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA. |
| first_indexed | 2024-04-11T21:51:52Z |
| format | Article |
| id | doaj.art-2ca6bd4d1bb14ecd8896068aa9856097 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T21:51:52Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-2ca6bd4d1bb14ecd8896068aa98560972022-12-22T04:01:13ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-08-011511810.1186/s13018-020-01827-yMetabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplastyCarol A. Lin0Phillip H. Behrens1Guy Paiement2W. David Hardy3James Mirocha4Robert L. Rettig5Heidi L. Kiziah6Andrew G. Rudikoff7Antonio Hernandez Conte8Department of Orthopedic Surgery, Cedars-Sinai Medical CenterDepartment of Orthopedic Surgery, Cedars-Sinai Medical CenterDepartment of Orthopedic Surgery, Cedars-Sinai Medical CenterDivision of Infectious Diseases, Johns Hopkins University School of MedicineDivision of Biostatistics & Bioinformatics, Cedars-Sinai Medical CenterDepartment of Surgery, Kaiser Permanente Los Angeles Medical CenterDepartment of Anesthesiology, Kaiser Permanente Los Angeles Medical CenterDepartment of Anesthesiology, Kaiser Permanente Los Angeles Medical CenterDepartment of Anesthesiology, Kaiser Permanente Los Angeles Medical CenterAbstract Background The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). Methods This study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period. Results Sixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection (p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection. Conclusions Immunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.http://link.springer.com/article/10.1186/s13018-020-01827-yHuman immunodeficiency virus (HIV)Total hip arthroplastySurgical site infection (SSI)Highly active antiretroviral therapy (HAART) |
| spellingShingle | Carol A. Lin Phillip H. Behrens Guy Paiement W. David Hardy James Mirocha Robert L. Rettig Heidi L. Kiziah Andrew G. Rudikoff Antonio Hernandez Conte Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty Journal of Orthopaedic Surgery and Research Human immunodeficiency virus (HIV) Total hip arthroplasty Surgical site infection (SSI) Highly active antiretroviral therapy (HAART) |
| title | Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| title_full | Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| title_fullStr | Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| title_full_unstemmed | Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| title_short | Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| title_sort | metabolic factors and post traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty |
| topic | Human immunodeficiency virus (HIV) Total hip arthroplasty Surgical site infection (SSI) Highly active antiretroviral therapy (HAART) |
| url | http://link.springer.com/article/10.1186/s13018-020-01827-y |
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