Influence of HIV infection on the outcomes of two-stage hip arthroplasty in septic coxitis

Introduction: Two-stage total hip arthroplasty for destructive septic coxitis using cemented articulating spacers with antibiotics is currently used by a very limited number of authors, in contrast to a similar approach used to treat hip periprosthetic infection. Data on the effectiveness of this method, based on the analysis of significant clinical observations, are presented only in a few studies, and there are no data on its use in patients with HIV infection.

Purpose of the study. Evaluation of the effectiveness of a two-stage hip arthroplasty using articulating cement spacers with antibiotics in the treatment of destructive forms of septic coxitis, including cases with HIV infection.

Materials and Methods. The study included 50 patients with septic coxitis, 51 of whom underwent hip joint debridement using cemented articulating spacers with antibiotics. The patients were divided into groups. Group 1 included 40 patients (41 cases) who were HIV-negative, and Group 2 included 10 patients with HIV infection. In Group 1, the second stage of surgical treatment was performed in 37 (90.2%) patients, while in Group 2, the second stage of surgical treatment was performed in 8 (80%) patients.

Results. A positive outcome of the surgical treatment was considered to be the completion of two stages of surgical treatment in the absence of infection of the hip endoprosthesis, as well as the restoration of the weight-bearing ability of the limb. Thus, in the Group 1, positive results were obtained in 34 (82.9%) of 41 cases. In the Group 2 - only in 4 (40%) of 10 cases. Functional results according to the HHS system were assessed only in patients who underwent both stages of surgical treatment, including cases with severe infectious complications, where the endoprosthesis was removed. The assessment in points according to the HHS system in the first group of patients (n = 37) gave a significant improvement in the average indicators: from 39.1 ± 10.7 (before surgical treatment) to 89.8 ± 11.2 (after obtaining the final result). A similar assessment in the 2nd group of patients with HIV infection (n=8) yielded the following data: 38.3±6.7 (before surgical treatment) and 51±7.8 (after assessing the final result).

Conclusion. The study demonstrated the reasonable effectiveness of two-stage hip arthroplasty for destructive septic coxitis in patients without HIV infection. In HIV-infected patients, the results were significantly worse due to the higher incidence of infectious complications in both the first and second stages of surgery.

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