Abstract
We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. Of the 26 cases that were reviewed at 1 year, no late sepsis was identified. All of the fractures, non-unions, osteotomies and arthrodeses united. The literature indicates that late sepsis following arthroplasty occurs more frequently in haemophiliacs who are HIV positive than their HIV-negative counterparts. It is still not certain whether or not such a risk also applies to HIV-positive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.
Résumé
Nous avons suivi de façon prospective 38 implants orthopédiques chez 36 malades HIV-Positifs. La radiographie et l’examen clinique ont été utilisés pour étudier l’évolution et ont été recherchées les infections précoces et tardives survenant dans l’année suivant la chirurgie. Deux malades sont morts de causes sans rapport avec l’implantation, deux malades avaient des implants retirés pour des raisons autre qu’une infection, et huit cas ont été perdus de vue. Des 26 cas qui ont été examinés à une année, aucune infection tardive n’a été identifiée. Toutes les fractures, pseudarthroses, osteotomies et arthrodèses ont fusionnées. La littérature indique que les infections tardives après arthroplastie surviennent plus fréquemment chez les hémophiles séro-positifs que chez ceux qui sont séro-négatifs. Il n’est pas encore certain qu’un tel risque s’applique aussi à malades séropositifs qui ne sont pas des haemophiles. Cette étude augmente la confiance dans le fait que l’utilisation d’implants orthopédiques chez des patients immuno déprimés avec une peau intacte est sûre, au moins pour la période ou l’implant est nécessaire. Des études supplémentaires sont nécessaires pour savoir si les implants de fixation devraient être enlevés ou non.
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Acknowledgements
The authors wish to thank Mr. J. Donaldson and Mr. J. Baker for their help in patient follow-up.
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