Optimal timing for elective total hip replacement in HIV-positive patients.

INTRODUCTION: Evidence about the optimal timing for total hip replacement (THR) in HIV-positive patients is scant.

HYPOTHESIS: Preoperative criteria: cluster of differentiation 4 (CD4) counts>200cells/mm3 and an undetectable HIV virus load before THR, improve infection rates, aseptic loosenings, and functional outcomes.

MATERIALS AND METHODS: We recruited 16 HIV-positive patients who had undergone 25 THRs between 2003 and 2015. None had hemophilia, and none were intravenous drug users (IVDUs).

RESULTS: Their mean age was 41.2 years (range: 24-60); minimum follow-up was 12 months (mean: 64.6); mean duration of prophylactic antibiotics was 2.9 days (range: 1-5); and mean hospital length of stay was 6.0 days (range: 4-11). No patients were treated with subsequent oral antibiotics. The mean preoperative CD4 count was 464.1±237.0 (range: 235-904)cells/mm3 . There were no early superficial surgical site infections, late periprosthetic joint infections, or aseptic loosenings. Post-surgery Harris Hip score was significantly (p<0.001) better.

DISCUSSION: A preoperative CD4 count>200cell/mm3 and an undetectable HIV virus load might indicate optimal timing for elective THRs in HIV-positive patients without hemophilia and not IVDUs.

LEVEL OF EVIDENCE: IV, retrospective or historical series.