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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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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Consultation for those who live a distance away from Seattle.

Click here to see the new Rotator Cuff Book

Check out the new Shoulder Arthritis Book - click here.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.