Orthopaedic surgery on the HIV-positive patient: complications and outcome

Orthopaedic surgeons practicing in areas with high prevalence of HIV-infected individuals may anticipate that up to 10% of their emergent cases and a highly variable percentage of elective cases will be HIV-positive. Basic science studies have demonstrated impairment of defenses to routine orthopaedic pathogens as well as opportunistic organisms. Clinical studies show that this impairment has not resulted in an increased incidence of postoperative infections or failure of wound healing in the asymptomatic HIV-positive patient. Current medical management seems adequate to prevent increased risk of early postoperative infection in the symptomatic HIV-positive patient undergoing orthopaedic procedures. The HIV-positive patient with a prosthetic implant may be at increased risk of late hematogenous implant infection as host defenses diminish. Regular medical attention, prophylactic antibiotics before dental work and any invasive procedures, and early evaluation and treatment of possible infections are especially important in this group. Because the risk of surgical complications increases with progression of the disease, guidelines for elective surgery should include an assessment of the HIV-positive patient's immune status. The CD4 cell count, history of opportunistic infection, serum albumen, skin anergy, and state of nutrition and general health probably provide the best information regarding the risk of postoperative complications. Based on current knowledge, orthopaedic surgeons should develop a general philosophy or guideline for elective and emergent surgery on the HIV-positive patient in various stages of disease.