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Cabrita HA, Santos ALDG, Gobbi RG, Lima ALM, Oliveira PR, Ejnisman L, Gurgel HMC, Uip D, Camanho GL. AVASCULAR NECROSIS OF THE FEMORAL HEAD IN HIV-INFECTED PATIENTS: PRELIMINARY RESULTS FROM SURGICAL TREATMENT FOR CERAMIC-CERAMIC JOINT REPLACEMENT. Rev Bras Ortop 2015; 47:626-30. [PMID: 27047876 PMCID: PMC4799464 DOI: 10.1016/s2255-4971(15)30014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 12/21/2011] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the initial functional results and early complication rate of ceramic-ceramic total hip replacements among patients living with HIV who presented osteonecrosis of the femoral head. Method: Twelve HIV–positive patients with a diagnosis of osteonecrosis of the incongruent femoral head were evaluated using clinical and laboratory criteria and the WOMAC functional scale before and after treatment with joint replacement. Results: We observed that 83.3% of the subjects were taking protease inhibitors, 75% had dyslipidemia and 66.6% had lipodystrophy syndrome. The improvement over the evolution of the WOMAC score was statistically significant at six and twelve months after the operation, in comparison with the preoperative score. We did not observe complications secondary to this procedure. Conclusion: Total hip arthroplasty with a ceramic-ceramic implant for treating avascular necrosis of the hip is an appropriate surgical option for this portion of the population. It provides a significant initial functional improvement and a low early complication rate.
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Affiliation(s)
- Henrique Amorim Cabrita
- Attending Physician in the Hip Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | - Alexandre Leme de Godoy Santos
- Attending Physician in the Foot and Ankle Group and in the Trauma Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Attending Physician in the Knee Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | - Ana Lúcia Munhoz Lima
- Collaborating Professor and Head of the CCIH, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | | | - Leandro Ejnisman
- Trainee in the Hip Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | - Henrique Melo Campos Gurgel
- Attending Physician in the Hip Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, Brazil
| | - David Uip
- Director of the Emílio Ribas Institute of Infectology, São Paulo, Brazil
| | - Gilberto Luis Camanho
- Titular Professor of the Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Lima ALLM, de Oliveira PRD, Plapler PG, Marcolino FMDA, de Souza Meirelles E, Sugawara A, Gobbi RG, dos Santos ALG, Camanho GL. Osteopenia and osteoporosis in people living with HIV: multiprofessional approach. HIV AIDS (Auckl) 2011; 3:117-24. [PMID: 22267944 PMCID: PMC3257973 DOI: 10.2147/hiv.s6617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.
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Affiliation(s)
- Ana Lucia Lei Munhoz Lima
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Priscila Rosalba D de Oliveira
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Perola Grimberg Plapler
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flora Maria D Andrea Marcolino
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Eduardo de Souza Meirelles
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - André Sugawara
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alexandre Leme Godoy dos Santos
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gilberto Luis Camanho
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Abstract
The considerable increase of the life expectancy of HIV-infected patients in the age of highly-powerful antiretroviral treatment results in important metabolic and bone-joint changes resulting from a long-lasting viral infection time and from this treatment. The most common orthopaedic complications are bone mineralization changes, osteonecrosis, carpal tunnel syndrome and gleno-humeral adhesive capsulitis, with different clinical presentation features, natural disease progression and therapeutic response compared to the overall population. Literature reports are initial, and the experience of the multidisciplinary service of the University of Sao Paulo's Institute of Orthopaedics and Traumatology enables us a more indepth knowledge about the various pathologies involved and the development of treatment protocols that are appropriate to these diagnoses.
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