Травматология и ортопедия России. 2019; 25: 117-125
Результаты лечения перипротезной инфекции крупных суставов у ВИЧ-позитивных больных
https://doi.org/10.21823/2311-2905-2019-25-4-117-125Аннотация
Актуальность. Существует ограниченное количество публикаций, в которых приведены результаты первичного эндопротезирования крупных суставов у пациентов с вирусом иммунодефицита человека (ВИЧ). Мы не смогли обнаружить работ, посвященных ревизионному эндопротезированию у больных с перипротезной инфекцией. Цель исследования — оценить краткосрочные результаты ревизионного эндопротезирования у ВИЧ-позитивных пациентов с наличием перипротезной инфекции тазобедренного и коленного суставов. Материал и методы. За период с 2015 г. по 2019 г. на лечении в клинике находилось 13 ВИЧ-позитивных пациентов с перипротезной инфекцией тазобедренного (10 случаев) и коленного (3 случая) суставов. Состояние пациентов оценивали при помощи клинических, лабораторных, рентгенологических методов. Проводилась оценка по шкале Harris Hip Score и Knee Society Score до и после операции. Результаты. Средний срок наблюдения составил 21,4±2,6 мес. У двух (15,4%) из 13 пациентов с перипротезной инфекцией было проведено успешное двухэтапное лечение. В пяти случаях (38,5%) контроль над инфекцией был достигнут путем выполнения резекционной артропластики и еще в одном (7,7%) — с помощью артродеза. Пятеро больных (38,5%) отказались от замены спейсера на эндопротез. Средняя оценка по HHS возросла незначительно — с 45,3±2,2 до 52,2±4,15 баллов после лечения (р = 0,2). Заключение. Несмотря на соблюдение международных протоколов лечения имплантат-ассоциированной инфекции, частота рецидивов у ВИЧ-позитивных больных в бессимптомной стадии остается очень высокой. Эффективность двухэтапного лечения с использованием антибактериального спейсера в нашей группе больных составила лишь 15,4%.
Список литературы
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15. Lin C.A., Kuo A.C., Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2013;95(11):1028-1036. doi: 10.2106/JBJS.L.00269.
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17. Boylan M.R., Basu N., Naziri Q., Issa K., Maheshwari A.V., Mont M.A. Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty? J Arthroplasty. 2015;30(9):1629-1632. doi: 10.1016/j.arth.2015.03.018.
18. Dimitriou D., Ramokgora M., Pietrzak J.R.T., van der Jagt D., Mokete L. Human Immunodeficiency Virus infection and hip and knee arthroplasty. J Bone Joint Surg Rev. 2017;5(9):e8. doi: 10.2106/JBJS.RVW.17.00029.
19. Capogna B.M., Lovy A., Blum Y., Kim S.J., Felsen U.R., Geller D.S. Infection rate following total joint arthroplasty in the HIV population. J Arthroplasty. 2013;28(8): 1254-1258. doi: 10.1016/j.arth.2012.12.021.
20. Zhao C.-S., Li X., Zhang Q., Sun S., Zhao R.-G., Cai J. Early outcomes of primary total hip arthroplasty for osteonecrosis of the femoral head in patients with Human Immunodeficiency Virus in China. Chin Med J (Engl). 2015;128(15): 2059-2064. doi: 10.4103/0366-6999.161364.
21. Habermann B., Eberhardt C., Kurth A.A. Total joint replacement in HIV positive patients. J Infect. 2008;57(1):41-46. doi: 10.1016/j.jinf.2008.01.045.
22. Wieser K., Zingg P.O., Betz M., Neubauer G., Dora C.J. Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg. 2012;132(7): 1037-1044. doi: 10.1007/s00402-012-1509-4.
23. Lin C.A., Takemoto S., Kandemir U., Kuo A.C., Mid-term outcomes in HIV-positive patients after primary total hip or knee arthroplasty. J Arthroplasty. 2014;29(2): 277-282. doi: 10.1016/j.arth.2013.06.015.
24. Guild G.N., Moore T.J., Barnes W., Hermann C. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res. 2012;470(5):1507-1512. doi: 10.1007/s11999-011-2223-1.
25. Pretell-Mazzini J., Subhawong T., Hernandez V.H., Campo R. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes. J Bone Joint Surg Am. 2016;98(9):775-786. doi: 10.2106/JBJS.15.00842.
26. Schwarz E.M., Parvizi J., Gehrke T., Aiyer A., Battenberg A., Brown S.A. et al. 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions. J Orthop Res. 2019;37(5):997-1006. doi: 10.1002/jor.24293.
Traumatology and Orthopedics of Russia. 2019; 25: 117-125
Treatment Outcomes of Periprosthetic Joint Infection in HIV-positive Patients
https://doi.org/10.21823/2311-2905-2019-25-4-117-125Abstract
Relevance. There is a limited number of publications reporting outcomes of primary large joint arthroplasty in patients with human immunodeficiency virus (HIV). The authors were unable to find papers on revision arthroplasty in patients with periprosthetic infection. Purpose of the study — to evaluate short term outcomes after revision arthroplasty in HIV-positive patients with periprosthetic infection of the hip and knee joint. Materials and methods. 13 HIV-positive patients with periprosthetic infection of the hip (10 cases) and knee (3 cases) joint underwent treatment in the period from 2015 to 2019. Patients were examined by clinical, laboratory and roentgenological methods. Harris Hip Score and Knee Society Score were used for evaluation prior to and after the surgery. Results. Mean follow up period was 21,4±2,6 months. Successful two-stage treatment was performed in two (15,4%) out of 13 patients with periprosthetic infection. In 5 cases (38,5%) control over infection was achieved by resection arthroplasty, and in one case (7,7%) – by arthrodesis. Five patients (38,5%) refused from interchange of spacer to prosthesis. Mean Harris Hip score demonstrated insignificant increase postoperatively — from 45,3±2,2 to 52,2±4,15 (р = 0,2). Conclusion. Despite following the international protocols for treatment of implant-associated infection the infection recurrence rate in HIV-positive patients in the asymptomatic phase remains very high. Efficiency of twostage treatment using antibacterial spacers in the present group of patients amounted only to 15,4%.
References
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2. Lehman C.R., Ries M.D., Piement G.D., Davidson A.B. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty. 2001;16(3):330-335. doi: 10.1054/arth.2001.21454.
3. Parvizi J., Sullivan T.A., Pagnano M.W., Trousdale R.T., Balander M.E. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty. 2003;18(3):259-264. doi: 10.1054/arth.2003.50094.
4. Naziri Q., Boylan M.R., Issa K., Jones L.C., Khanuja H.S., Mont M.A. Does HIV infection increase the risk of Perioperative Complications after THA? A Nationwide Database Study. Clin Orthop Relat Res. 2015;473(2): 581-586. doi: 10.1007/s11999-014-3855-8.
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7. Tan T.L., Maltenfort M.G., Chen A.F., Shahi A., Higuera C.A. Siquera M., Parvizi J. Development and Evaluation of a Preoperative Risk Calculator for Periprosthetic Joint Infection Following Total Joint Arthroplasty. J Bone Joint Surg Am. 2003;100(9):777-785. doi: 10.2106/JBJS.16.01435.
8. Pokrovskii V.I., Pokrovskii V.V., Yurin O.G. Klinicheskaya klassifikatsiya VICh-infektsii. Epidemiologiya i infektsionnye bolezni. 2001;(1):7-10.
9. Parvizi J., Sullivan T.A., Pagnano M.W., Trousdale R.T., Bolander M.E. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty. 2003;18(3):259-264. doi: 10.1054/arth.2003.50094.
10. Insall J.N., Dorr L.D., Scott R.D., Scott W.N. Rationale of the Knee Society clinical system. Clin Orthop Relat Res. 1989;(248):13-14.
11. Enayatollahi M.A., Parvizi J. Diagnosis of infected total hip arthroplasty. Hip Int. 2015;25(4):294-300. doi: 10.5301/hipint.5000266.
12. Tsukayama D.T., Estrada R., Gustilo R.B. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78(4):512-523.
13. Della Valle C.J., Paprosky W.G. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res. 2004;(420):55-62. doi: 10.1097/00003086-200403000-00009.
14. Qiu Y.Y, Yan C.H., Chiu K.Y, Ng F.Y. Review article: bone defect classifications in revision total knee arthroplasty. J Orthop Surg (Hong Kong). 2011;19(2):238-242. doi: 10.1177/230949901101900223.
15. Lin C.A., Kuo A.C., Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2013;95(11):1028-1036. doi: 10.2106/JBJS.L.00269.
16. Morse C.G., Mican J.M., Jones E.C., Joe J.O., Rick M.E., Formentini E., Kovacs J.A. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis. 2007;44(5):739-748.
17. Boylan M.R., Basu N., Naziri Q., Issa K., Maheshwari A.V., Mont M.A. Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty? J Arthroplasty. 2015;30(9):1629-1632. doi: 10.1016/j.arth.2015.03.018.
18. Dimitriou D., Ramokgora M., Pietrzak J.R.T., van der Jagt D., Mokete L. Human Immunodeficiency Virus infection and hip and knee arthroplasty. J Bone Joint Surg Rev. 2017;5(9):e8. doi: 10.2106/JBJS.RVW.17.00029.
19. Capogna B.M., Lovy A., Blum Y., Kim S.J., Felsen U.R., Geller D.S. Infection rate following total joint arthroplasty in the HIV population. J Arthroplasty. 2013;28(8): 1254-1258. doi: 10.1016/j.arth.2012.12.021.
20. Zhao C.-S., Li X., Zhang Q., Sun S., Zhao R.-G., Cai J. Early outcomes of primary total hip arthroplasty for osteonecrosis of the femoral head in patients with Human Immunodeficiency Virus in China. Chin Med J (Engl). 2015;128(15): 2059-2064. doi: 10.4103/0366-6999.161364.
21. Habermann B., Eberhardt C., Kurth A.A. Total joint replacement in HIV positive patients. J Infect. 2008;57(1):41-46. doi: 10.1016/j.jinf.2008.01.045.
22. Wieser K., Zingg P.O., Betz M., Neubauer G., Dora C.J. Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg. 2012;132(7): 1037-1044. doi: 10.1007/s00402-012-1509-4.
23. Lin C.A., Takemoto S., Kandemir U., Kuo A.C., Mid-term outcomes in HIV-positive patients after primary total hip or knee arthroplasty. J Arthroplasty. 2014;29(2): 277-282. doi: 10.1016/j.arth.2013.06.015.
24. Guild G.N., Moore T.J., Barnes W., Hermann C. CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive. Clin Orthop Relat Res. 2012;470(5):1507-1512. doi: 10.1007/s11999-011-2223-1.
25. Pretell-Mazzini J., Subhawong T., Hernandez V.H., Campo R. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes. J Bone Joint Surg Am. 2016;98(9):775-786. doi: 10.2106/JBJS.15.00842.
26. Schwarz E.M., Parvizi J., Gehrke T., Aiyer A., Battenberg A., Brown S.A. et al. 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions. J Orthop Res. 2019;37(5):997-1006. doi: 10.1002/jor.24293.
