Outcomes of Revision Arthroplasty for Hip Joint Infection in Matched Groups of HIV-Positive and HIV-Negative Patients

Abstract

Background: Several studies reported on periprosthetic infection after primary THA in HIV-positive patients, but very few showed the results of its revision. Objective: The aim was to compare primary and secondary clinical outcomes after revision arthroplasty for hip joint infection in matched groups of HIV-infected and HIV-negative patients. Methods: Using the hospital database, thirteen HIV-positive patients (13 infected hips) and thirteen HIV-negative patients of the matched control group (13 infected hips) were identified and their records were studied retrospectively. They underwent revision surgery aimed at infection arrest and total hip replacement due to infection developed after primary THA or infected spacers. Harris Hip Score, reinfection rate, limb shortening, and definite outcomes were evaluated with Wilcoxon, Mann-Whitney, and Chi-squared tests. Results and Discussion: Spacers with antibiotics were implanted in patients of both groups at the first step of revision, except for one HIV-infected patient who had resection arthroplasty. The mean follow-up was 29.4 ± 2.7 and 33. ± 2.9 months for the HIV-group and control group, respectively. Three patients of the HIV-group completed two-stage revision arthroplasty versus ten patients from the control group. Re-infection rate was higher in the HIV-group. At final follow-ups, the mean HHS was significantly different (53 ± 3.2 points in the HIV-group versus 79.14 ± 3.1 points in the control group) along with limb length discrepancy (3.71 ± 0.43 versus 1.4 ± 0.32). Conclusion: Both primary and secondary clinical outcomes of revision arthroplasty for hip joint infection in HIV-positive patients were significantly worse than in the matched group of HIVnegative patients. Revisions in HIV-positive group resulted in a higher reinfection rate, a small number of definite two-stage revisions, and lower functional scores.