Implant orthopaedic surgery in HIV asymptomatic carriers: Management and early outcome

Background: To the best of our knowledge, no reports currently exist on how to manage HIV infected patients in cases where they present with an absolute indication for implant surgery. The aim of this study was to compare the immediate and early outcome of implant orthopaedic surgery in HIV carriers with less than 500 CD4/ml (group A) treated with a protective antiretroviral therapy and prolonged prophylactic antibiotic therapy in one group, and in the other group, HIV carriers with more than 500 CD4/ml (group B) and non-HIV carriers (group C) treated conventionally. Methods: During a 36-month-period, a protocol of screening and subsequent management of HIV carriage was proposed to patients admitted for internal clean trauma or orthopaedic implant surgery in our department. The HIV screening, its confirmation and the CD4 count were carried out by conventional methods. All group A patients were treated with cefuroxime for 10 days and a fixed combination of antiretroviral tritherapy before or just after surgery. Group B and C patients solely underwent surgery with a conventional 1.5 g of cefuroxime. The wounds in the three groups were later examined at days 2, 7, 14, 45 and at 3 months. The rates of clinical wound infection were compared using the Fisher exact test; the difference was considered significant if p ≤ 0.05. Results: Six hundred and forty-six patients were selected for this protocol, due to fresh fractures in 544 (84.21%) cases, non-union in 41 (6.34%), mal-union in 17 (2.63%), aseptic necrosis in 16 (2.47%) and osteoarthritis in 28 (4.33%). During surgery, IM nailing was performed in 351 (54.33%) patients, plating in165 (25.54%), pinning or wiring in 31 (4.79%) and finally, arthroplasty in 99 (15.32%) among which 45 were total hip replacements. Regarding HIV carriage and immune status, 44 patients were of group A, 30 of group B and 572 of group C. Two cases of infection were observed in both group A (4.54%) and group B (6.66%), and 37 in group C (6.46%). The differences were statistically non-significant. Conclusions: The authors conclude that if a prolonged prophylactic antibiotic therapy and systematic antiretroviral therapy are given to HIV immune-depressed carriers undergoing implant orthopaedic surgery, their post-operative infection risk may be close to that of non-HIV carriers. © 2008 Elsevier Ltd. All rights reserved.