Saturday, April 30, 2016

Total shoulder arthroplasty in patients with HIV/AIDS - high rate of complications

Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends

These authors identified 2528 HIV-positive patients who underwent TSA or reverse TSA (RTSA) from the 2005 to 2012 Medicare database. 1353 patients had 2-year follow-up.

HIV-positive patients had a 36 times higher rates of 90-day cerebrovascular accidents within 90 days of the procedure.  (OR, 35.98; CI, 30.34-42.67). 
HIV-positive patients had higher overall rates of broken prosthetic joints (OR, 1.72; CI, 1.20-2.47), periprosthetic infection (OR, 1.36; CI, 1.01-1.82), and TSA revision or repair (OR, 2.44; CI, 1.81-3.28).

Here are the short term medical complications
 The short term surgical complications
 And the long term surgical complications

Comment: Over one in 50 total shoulders are performed on HIV positive individuals and this percentage is rising with time. The increase in complication rate is impressive.

This study provides excellent information for the preoperative informed consent discussion as well as pointing to the need for special care during the preoperative period and close followup in the post operative period so that the effect of these complications can be minimized.

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