Total Joint Arthroplasty in HIV-Positive Patients in Malawi

Background:. In this observational study, we describe the medium-term outcomes of total joint arthroplasty (TJA) in human immunodeficiency virus (HIV)-positive patients in Malawi, a low-income country. With a high prevalence of HIV and increasing arthroplasty rates in low and middle-income countries...

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Autores principales:	Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhD, Luke Render, MBBS, MRCS, BSc(Hons), Chipiliro Moffat, Nicholas Lubega, MBChB, MMed(Ortho), FCS(ECSA), MBA, Nyengo Mkandawire, BMBS, FRCS, MCh(ORTH), FCS(ECSA), Sven Young, MD, PhD, FCS(ECSA), William J. Harrison, MA(Oxon), FRCS(Tr&Orth)
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/ad0f0b6f69c144088120abaa81b70a2a
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spelling	oai:doaj.org-article:ad0f0b6f69c144088120abaa81b70a2a2021-11-25T07:59:02ZTotal Joint Arthroplasty in HIV-Positive Patients in Malawi2472-724510.2106/JBJS.OA.21.00022https://doaj.org/article/ad0f0b6f69c144088120abaa81b70a2a2021-12-01T00:00:00Zhttp://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00022https://doaj.org/toc/2472-7245Background:. In this observational study, we describe the medium-term outcomes of total joint arthroplasty (TJA) in human immunodeficiency virus (HIV)-positive patients in Malawi, a low-income country. With a high prevalence of HIV and increasing arthroplasty rates in low and middle-income countries, understanding the outcomes of TJA in this unique cohort of patients is essential to ensure that surgical practice is evidence-based. Methods:. Data for all HIV-positive patients who had TJA from January 2005 to March 2020 were extracted from the National Arthroplasty Registry of the Malawi Orthopaedic Association (NARMOA). From January 2005 to March 2020, a total of 102 total hip arthroplasties (THAs) and 20 total knee arthroplasties (TKAs) were performed in 97 patients who were HIV-positive and without hemophilia or a history of intravenous drug use. The mean length of follow-up was 4 years and 3 months (range, 6 weeks to 15 years) in the THA group and 4 years and 9 months (range, 6 weeks to 12 years) in the TKA group. The mean patient age was 50 years (range, 21 to 76 years) and 64 years (range, 48 to 76 years) at the time of THA and TKA, respectively. Results:. The primary indication for THA was osteonecrosis (66 hips). In the THA group, the mean preoperative Oxford Hip Score and Harris hip score were 14.0 (range, 2 to 33) and 29.4 (range, 1 to 64), respectively, and improved to 46.6 (range, 23 to 48) and 85.0 (range, 28 to 91) postoperatively. The primary indication for TKA was osteoarthritis (19 knees). The mean preoperative Oxford Knee Score was 14.9 (range, 6 to 31) and increased to 46.8 (range, 40 to 48) postoperatively. In patients who underwent THA, there was 1 deep infection (1 of 102 procedures), and 6 patients developed aseptic loosening (6 of 102). There was 1 postoperative superficial infection following TKA (1 of 20 procedures), and 1 patient developed aseptic loosening (1 of 20). Postoperative 6-week mortality among all patients was zero. Conclusions:. To our knowledge this is the largest medium-term follow-up of HIV-positive patients, without hemophilia or a history of intravenous drug use, who have had TJA in a low-income country. This study demonstrated good medium-term results among HIV-positive patients undergoing TJA, low complication rates, and improvements in patient-reported outcome measures. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhDLuke Render, MBBS, MRCS, BSc(Hons)Chipiliro MoffatNicholas Lubega, MBChB, MMed(Ortho), FCS(ECSA), MBANyengo Mkandawire, BMBS, FRCS, MCh(ORTH), FCS(ECSA)Sven Young, MD, PhD, FCS(ECSA)William J. Harrison, MA(Oxon), FRCS(Tr&Orth)Wolters KluwerarticleOrthopedic surgeryRD701-811ENJBJS Open Access, Vol 6, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhD Luke Render, MBBS, MRCS, BSc(Hons) Chipiliro Moffat Nicholas Lubega, MBChB, MMed(Ortho), FCS(ECSA), MBA Nyengo Mkandawire, BMBS, FRCS, MCh(ORTH), FCS(ECSA) Sven Young, MD, PhD, FCS(ECSA) William J. Harrison, MA(Oxon), FRCS(Tr&Orth) Total Joint Arthroplasty in HIV-Positive Patients in Malawi
description	Background:. In this observational study, we describe the medium-term outcomes of total joint arthroplasty (TJA) in human immunodeficiency virus (HIV)-positive patients in Malawi, a low-income country. With a high prevalence of HIV and increasing arthroplasty rates in low and middle-income countries, understanding the outcomes of TJA in this unique cohort of patients is essential to ensure that surgical practice is evidence-based. Methods:. Data for all HIV-positive patients who had TJA from January 2005 to March 2020 were extracted from the National Arthroplasty Registry of the Malawi Orthopaedic Association (NARMOA). From January 2005 to March 2020, a total of 102 total hip arthroplasties (THAs) and 20 total knee arthroplasties (TKAs) were performed in 97 patients who were HIV-positive and without hemophilia or a history of intravenous drug use. The mean length of follow-up was 4 years and 3 months (range, 6 weeks to 15 years) in the THA group and 4 years and 9 months (range, 6 weeks to 12 years) in the TKA group. The mean patient age was 50 years (range, 21 to 76 years) and 64 years (range, 48 to 76 years) at the time of THA and TKA, respectively. Results:. The primary indication for THA was osteonecrosis (66 hips). In the THA group, the mean preoperative Oxford Hip Score and Harris hip score were 14.0 (range, 2 to 33) and 29.4 (range, 1 to 64), respectively, and improved to 46.6 (range, 23 to 48) and 85.0 (range, 28 to 91) postoperatively. The primary indication for TKA was osteoarthritis (19 knees). The mean preoperative Oxford Knee Score was 14.9 (range, 6 to 31) and increased to 46.8 (range, 40 to 48) postoperatively. In patients who underwent THA, there was 1 deep infection (1 of 102 procedures), and 6 patients developed aseptic loosening (6 of 102). There was 1 postoperative superficial infection following TKA (1 of 20 procedures), and 1 patient developed aseptic loosening (1 of 20). Postoperative 6-week mortality among all patients was zero. Conclusions:. To our knowledge this is the largest medium-term follow-up of HIV-positive patients, without hemophilia or a history of intravenous drug use, who have had TJA in a low-income country. This study demonstrated good medium-term results among HIV-positive patients undergoing TJA, low complication rates, and improvements in patient-reported outcome measures. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
format	article
author	Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhD Luke Render, MBBS, MRCS, BSc(Hons) Chipiliro Moffat Nicholas Lubega, MBChB, MMed(Ortho), FCS(ECSA), MBA Nyengo Mkandawire, BMBS, FRCS, MCh(ORTH), FCS(ECSA) Sven Young, MD, PhD, FCS(ECSA) William J. Harrison, MA(Oxon), FRCS(Tr&Orth)
author_facet	Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhD Luke Render, MBBS, MRCS, BSc(Hons) Chipiliro Moffat Nicholas Lubega, MBChB, MMed(Ortho), FCS(ECSA), MBA Nyengo Mkandawire, BMBS, FRCS, MCh(ORTH), FCS(ECSA) Sven Young, MD, PhD, FCS(ECSA) William J. Harrison, MA(Oxon), FRCS(Tr&Orth)
author_sort	Simon Matthew Graham, MBChB, MRCS, MSc(Res), FRCS(Tr&Orth), PhD
title	Total Joint Arthroplasty in HIV-Positive Patients in Malawi
title_short	Total Joint Arthroplasty in HIV-Positive Patients in Malawi
title_full	Total Joint Arthroplasty in HIV-Positive Patients in Malawi
title_fullStr	Total Joint Arthroplasty in HIV-Positive Patients in Malawi
title_full_unstemmed	Total Joint Arthroplasty in HIV-Positive Patients in Malawi
title_sort	total joint arthroplasty in hiv-positive patients in malawi
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/ad0f0b6f69c144088120abaa81b70a2a
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Total Joint Arthroplasty in HIV-Positive Patients in Malawi

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