HIV IN ORTHOPAEDICS

HIV IN ORTHOPAEDICS

• Transmission of disease to surgeon from patient
• chance of transmission by needle prick or surgical instrument injury is 0.3%
• screen all patients – window period – take universal barrier precaution for all patients
• contamination occurs – immediate cleaning under running water
• post exposure prophylaxis
  • start within 2hrs
  • 2 reverse transcriptase inhibitors (Zidovudine and Lamivudine) and a protease inhibitor (Indinavir) – for 4 wks
  • Zidovudine – 250 mg – BD
  • Lamivudine – 150mg – BD
  • Indinavir – 800mg – TDS
  • baseline HIV test to be done immediately
  • repeat test after 12 wks to determine seroconversion
  • hepatitis prophylaxis should also be initiated

• Transmission of disease from infected surgeon to non infected patient
  • chance is very rare
• Trauma and HIV patients
  • Polytrauma
    • such patients more susceptible to acute lung injury / RDS – secondary infection
  • Closed #
    • problems are – wound infection after ORIF – late sepsis around implant – delay/ non union of # - unfavorable functional outcome
    • important determinants after ORIF are – CD 4 cell count – level of aseptic methods – soft tissue handling
    • Staph aureus most common pathogen
    • others are fungal and slow growing mycobacterial
    • aseptic precautions and I gen cephalosporins
  • Compound #
    • high risk of infection occurrence (42%)
    • early debridement, prophylaxis, antibiotics and rigid external fixators
• Musculoskeletal syndromes in HIV infected patients
  • MC musculoskeletal syndromes seen in HIV infected are
    • manifestations of drug toxicity
    • reactive arthritis – foot and ankle mainly
    • infective arthritis – mc in I/v drug abusers and hemophiliacs – staph aureus and staph pneumoniae
    • osteomyelitis
    • myositis
    • tendinitis – achilles tendon, anterior and posterior tibial tendons commonly
    • bursitis
  • HIV infection alters the clinical presentation, severity and course of disease
  • osteomyelitis can occur primarily but mc by extension of septic arthritis – total joint prosthesis increases chance of infection as immuno suppression progresses
  • most common complaint is myositis
    • idiopathic myositis
    • polymyositis secondary to zidovudine toxicity
    • pyomyositis
  • in idiopathic and polymyositis
    • pain, muscle weakness, raised CPK
    • muscle biopsy : myofibril necrosis, associated inflammation
  • in pyomyositis
    • staph aureus – solitary or multiple abscess within the muscle
    • pain, localized swelling, erythema
    • treatment – aspiration, systemic antibiotics

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