Hip arthroplasty in HIV-infected patients

We conducted a prospective study evaluating the clinical outcome of the arthroplasty in HIV-infected patients. Between July 2000 to August 2001, 14 patients (mean age 42 years) underwent uncemented total hip replacement for osteonecrosis (10 patients) and neglected neck of femur fractures (four patients). Patients were classified according to the WHO and CDC classification and were operated by a single surgeon using the Hardinge approach. At a mean follow-up of 72 months, all patients were fully ambulant. The mean total lymphocyte count (TLC) was 2.24 cells/mm³, CD4-425 cells/mm³, CD8-873 cells/mm³ and CD4 /CD8-0.52. In three patients the CD4 counts declined to <200 and they are presently receiving antiretroviral therapy. There was no loosening, infection or dislocation. One patient sustained a periprosthetic fracture which was treated successfully non-operatively. We conclude that total hip replacement in HIV-infected patients who have not progressed to WHO stage IV can be rewarding and the procedure does not carry an increased risk of postoperative infection.