Joint replacement for avascular necrosis in people living with HIV

Francesco Pisanu; Vito Fiore; Martina Corradi; Elisabetta Esposito; Ivana Maida; Gianfilippo Caggiari; Corrado Ciatti; Andrea Fabio Manunta; Carlo Doria

doi:10.23750/abm.v92iS3.12551

Joint replacement for avascular necrosis in people living with HIV

Authors

Francesco Pisanu Orthopedics and Traumatology Department, University of Sassari, Italy https://orcid.org/0000-0001-8780-5706
Vito Fiore Infectious Diseases Department, Viale San Pietro 24, 07100 Sassari, Italy
Martina Corradi Orthopedics and Traumatology Department, University of Sassari, Italy
Elisabetta Esposito Orthopedics and Traumatology Department, University of Sassari, Italy
Ivana Maida Infectious Diseases Department, University of Sassari, Italy
Gianfilippo Caggiari Orthopedics and Traumatology Department, University of Sassari, Italy
Corrado Ciatti Orthopedics and Traumatology Department, University of Sassari, Italy https://orcid.org/0000-0002-7094-4344
Andrea Fabio Manunta Orthopedics and Traumatology Department, University of Sassari, Italy
Carlo Doria Orthopedics and Traumatology Department, University of Sassari, Italy

DOI: https://doi.org/10.23750/abm.v92iS3.12551

Keywords:

People living with HIV, avascular necrosis, highly active antiretroviral therapy, joint replacement, total hip arthroplasty

Abstract

Recently, the interest on multifocal avascular necrosis (AVN) among people living with HIV (PLWH) is rising. PLWH have an incidence of symptomatic AVN significantly higher than the general population. The chronic viral infection may induce a direct damage via necrotizing vasculitis, on the other hand the highly active antiretroviral therapy represents a probable risk factor as it can indirectly lead to multifocal necrosis. Regardless of etiopathology, the AVN management in PLWH is the same as in the general population. Depending on symptoms, stage, and location, the AVN can be treated conservatively or surgically, but in its final stages joint replacement is often the most appropriate therapeutic option. The safety and outcomes of such major orthopedic surgery in PLWH are debated topics. In agreement with the literature in our case series we observed, despite some complication, a significant pain relief and excellent recovery of function after hip replacements. Although increased complication rates, several other independent risk factors associated with HIV infection can act as confounding factors. These confounders must be taken into account both in clinical practice and in data analysis. This case-based review highlights the increasing incidence of AVN in PLWH, and emphasizes the safety and effectiveness of the prosthetic joint replacement in this population.

References

Ficat R, "Idiopathic bone necrosis to the femoral head early diagnosis and treatment," British editorial society of bone and joint surgery, 1985, Vols. vol. 67-b, no. 1. https://doi.org/10.1302/0301-620X.67B1.3155745

Pijnenburg L, Felten R, Javier R M, "Ostéonécroses aseptiques, une revue générale des ostéonécroses de la hanche, et au-delà (A review of avascular necrosis, of the hip and beyond)," Rev Med Interne, 2020, pp. 41(1):27-36. DOI: 10.1016/j.revmed.2019.10.332

Seijas R, Sallent A, Rivera E, Ares O, "Avascular Necrosis of the Femoral Head.," J Invest Surg., 2019, pp. 32(3):218-219. https://doi.org/10.1080/08941939.2017.1398282

Hernigou P, Hernigou J, Scarlat M., "Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification.," Orthop Surg., 2020, pp. 12(5):1340-1349. https://doi.org/10.1111/os.12788

Reddy R,Daftary N M; Delapenha R, Dutta A, "Avascular Necrosis and Protease Inhibitors",. J Natl Med Assoc. 2005; 97(11):1543-1546. https://pubmed.ncbi.nlm.nih.gov/16334502/

Mankin HJ, "Non traumatic Necrosis of the bone (osteonecrosis)," N Engl J Med, 1992, no. 326(22):1473-9. DOI: 10.1056/NEJM199205283262206

Pisanu F, Pes M, Caggiari G, Ortu S, Satta M L, Amorese V et al, "Total hip arthroplasty: Concerns and precaution in sickle-cell trait," Journal of Orthopaedics, vol. 18, pp. 117-120, 2019. DOI: 10.1016/j.jor.2019.11.038

Adarraga MD, Sanchez-Martinéz F, Caracuel MA, Escudero A, Collantes E. A Case of Multiple Osteonecrosis in a Patient with HIV: Effect of Joint Lavage. Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases. 2000 Feb;6(1):41-44. DOI: 10.1097/00124743-200002000-00007

Brown P, Crane L, "Avascular necrosis of bone in patients with human immunodeficiency virus infection: report of 6 cases and review of the literature," Clin Infect Dis, 2001, vol. 32, p. 1221–1226. https://doi.org/10.1086/319745

Kim-Orden M, Barrett K, Khatod M, "Algorithm for Treatment of Hip and Knee Osteonecrosis: Review and a Presentation of Three Example Cases," J Rheumatology Dis Treat, 2017, vol. 3, p. 053. http://doi.org/10.23937/2469-5726/1510053

Graham S M , Lubega N, Mkandawire N , Harrison W J, "Total hip replacement in HIV-positive patients," Bone Joint Journal, 2014, vol. 96 b, pp. 462-466. https://doi.org/10.1302/0301-620X.96B4.33213

Ortiguera C J, Pulliam I T, Cabanela M E, "Total hip ar throplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up.," J arthroplasty, 1999, vol. 14, pp. 21-28. https://doi.org/10.1016/S0883-5403(99)90197-3

Jawad M U, Haleem A A, Scully S P, "In brief: Ficat classification: avascular necrosis of the femoral head.," Clin Orthop Relat Res., 2012, vol. 470(9), pp. 2636-2639. https://doi.org/10.1007/s11999-012-2416-2

Nilsdotter A, Bremander A, "Measure of hip function and symptoms: Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome score (HOOS), Oxford hip score (OHS), Lequesne Index of Severity for Osteoarthritis of the hip (LISOH) and American Academy of Orthopedic surgeons” Arthritis Care res, 2011, vol. 63 Suppl 11, pp. 200-207. https://doi.org/10.1002/acr.20549

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987 Jan;(214):160-4. PMID: 3791738.

Glanzmann M C, Kolling C, Schwyzer H K, Audigé L, "Conversion to hemiarthroplasty as a salvage procedure for failed reverse shoulder arthroplasty as a salvage procedure for failed reverse shoulder arthroplasty," J Shoulder Elbow, 2016, vol. 25, pp. 1795-1802. https://doi.org/10.1016/j.jse.2016.03.011

Bayard C, Ledergerber B, Flepp M, Lecompte T, Moulin E, Hoffmann M et al., "Swiss HIV Cohort Study. Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study.," Open Forum Infect Dis., 2017, vol. 4(4): ofx177. https://doi.org/10.1093/ofid/ofx177

Permpalung N, Ungprasert P, Summachiwakij S, Leeaphorn N, Knight E L, "Protease inhibitors and avascular necrosis: a systematic review and meta-analysis," Int J Antimicrob Agents.,2014, vol. 44(2), pp. 93-95. DOI: 10.1016/j.ijantimicag.2014.02.011

Green KR, Hernandez -Jimenez J.M, Isache C.L., Jacob R. , "Avascular necrosis: a growing concern for the HIV population.," BMJ, 2018, Case Reports 2018; 2018:bcr-2017-2216788. DOI: 10.1136/bcr-2017-221678

Borges Á H, Hoy J, Florence E, Sedlacek D, Stellbrink H J, Uzdaviniene V et al., "Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort," Clinical Infectious Diseases, 2017, 64(10):1413-1421. https://doi.org/10.1093/cid/cix167

Mazzotta E, Agostinone A, Rosso R, Di Biagio A, De Socio G V, Cappelletti A et al. , " Osteonecrosis in human immunodeficiency virus (HIV)-infected patients: a multicentric case-control study.," J Bone Miner Metab, 2011.vol. 29(3), p. 383–388. DOI: 10.1007/s00774-010-0245-5

Pisanu F, Andreozzi M, Costagli F, Caggiari G, Saderi L, Sotgiu G, Manunta AF. Resumption of physical activity and sport after knee replacement. J Orthop. 2020 Jan 25;20:247-250. DOI: 10.1016/j.jor.2020.01.033

Pisanu F, Andreozzi M, Fiori E, Altamore F, Bartoli M, Caggiari G, Ortu S, Rios M, Manunta AF, Doria C. Surgical management of hip prosthetic failure in metallosis: A case series and literature review. J Orthop. 2021 Oct 13;28:10-20. doi: 10.1016/j.jor.2021.10.002

Manca A, Pisanu F, Ortu E, De Natale E. Ginatempo F. Dragone D, et all. Isokinetic cross-training effect in foot drop following common peroneal nerve injury. Isokinet Exerc Sci, 23 (2015), pp. 17-20. DOI: 10.3233/IES-140559

Caggiari G, Ciurlia E, Ortu S, Sirianni R, Bonini L, Pisanu F, Doria C, Manca M. Osteochondral avulsion fracture of the posteromedial tibial plateau. Trauma Case Rep. 2020 Jan 8;25:100281. doi: 10.1016/j.tcr.2020.100281