Thursday, November 17, 2016

Total shoulder arthroplasty in patients with HIV - when does it make sense?

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) in the 2005 to 2012. Medicare database. 1353 patients had 2-year follow-up. The percentage of TSA/RTSA done for HIV positive patients is on the increase

These patients had a higher prevalence of comorbidities. 

These patients had significantly higher rates of 7 to 30 medical complications

Particularly impressive was the 45 times higher risk of stroke CVA.

 In addition to the medical complications,  HIV-positive patients had higher overall rates surgical complications, including 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).

Comment: These data remind us that shoulder arthroplasty is in almost all cases and elective procedure. The 'indications' for these procedures are not 'arthritis' or 'cuff tear arthropathy' but rather a patient who has a good chance of benefitting from the surgery, considering not only the shoulder pathology but also the risk factors for complications and poor results. We need to be prepared for the situation where the shoulder 'needs' surgery, but the patient doesn't.


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