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Total knee arthroplasty in patients with a history of illicit intravenous drug abuse

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Abstract

Purpose

Injection drug users are at high risk for both infection with blood-borne pathogens, namely, human immune deficiency virus (HIV), hepatitis-B, -C virus, various bacterial infections, as well as early primary and secondary joint degeneration. When total knee arthroplasty (TKA) is anticipated the risk of septic complications is a major concern. The purpose of this study was to assess the clinical and radiographic outcome of patients with a history of intravenous drug use after total knee arthroplasty. The primary outcome was revision rate. Secondary outcomes were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Society Score (KSS) and radiographic loosening.

Methods

We retrospectively reviewed the records of 1,692 TKA performed or revised in our institution. Data of 18 TKA in 12 patients (11 male, 1 female; average age 42, range 23–62 years) with a history of intravenous opioid abuse were available for final analysis.

Results

The mean follow up was 125 (range 25–238) months. Seven patients required revision surgery due to periprosthetic joint infection after 62 months (range 5–159): one two staged revision, three arthrodesis and three amputations. The median prosthesis survival was 101 (95%-CI 48–154) months.

Conclusion

Total knee arthroplasty in patients with a history of intravenous drug abuse is associated with major complications, including above-the-knee amputation. If permanent abstinence from intravenous drug abuse is doubtful, other therapeutic options including primary arthrodesis should be considered.

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References

  1. United Nations Office on Drugs and Crime (2005) World drug report, vol 1. UNODC, New York

  2. EMCDDA (2010) Trends in injecting drug use in Europe. European Monitoring Center for Drugs and Drug Addiction, Publications office of the European Union, Luxembourg

    Google Scholar 

  3. Scheidegger C, Zimmerli W (1989) Infectious complications in drug addicts: seven-year review of 269 hospitalized narcotics abusers in Switzerland. Rev Infect Dis 11(3):486–493

    Article  CAS  PubMed  Google Scholar 

  4. Esteban R (1993) Epidemiology of hepatitis C virus infection. J Hepatol 17(Suppl 3):S67–S71

    Article  PubMed  Google Scholar 

  5. Levine OS, Vlahov D, Nelson KE (1994) Epidemiology of hepatitis B virus infections among injecting drug users: seroprevalence, risk factors, and viral interactions. Epidemiol Rev 16(2):418–436

    Article  CAS  PubMed  Google Scholar 

  6. Des Jarlais DC, Friedman SR, Choopanya K, Vanichseni S, Ward TP (1992) International epidemiology of HIV and AIDS among injecting drug users. AIDS 6(10):1053–1068

    Article  CAS  PubMed  Google Scholar 

  7. Louria DB, Hensle T, Rose J (1967) The major medical complications of heroin addiction. Ann Intern Med 67(1):1–22

    Article  CAS  PubMed  Google Scholar 

  8. Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, Montaner JS (1998) Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA 279(6):450–454

    Article  CAS  PubMed  Google Scholar 

  9. Chandrasekar PH, Narula AP (1986) Bone and joint infections in intravenous drug abusers. Rev Infect Dis 8(6):904–911

    Article  CAS  PubMed  Google Scholar 

  10. Mazzotta E, Agostinone A, Rosso R, Di Biagio A, De Socio GV, Cappelletti A, Zicolella R, Polilli E, Bonfanti P, Di Matteo L, Manzoli L, Parruti G (2011) Osteonecrosis in human immunodeficiency virus (HIV)-infected patients: a multicentric case-control study. J Bone Miner Metab 29(3):383–388. https://doi.org/10.1007/s00774-010-0245-5

    Article  PubMed  Google Scholar 

  11. Wieser K, Zingg PO, Betz M, Neubauer G, Dora C (2012) Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg 132(7):1037–1044. https://doi.org/10.1007/s00402-012-1509-4

    Article  PubMed  Google Scholar 

  12. Gordon RJ, Lowy FD (2005) Bacterial infections in drug users. N Engl J Med 353(18):1945–1954. https://doi.org/10.1056/NEJMra042823

    Article  CAS  PubMed  Google Scholar 

  13. Shekar R, Rice TW, Zierdt CH, Kallick CA (1985) Outbreak of endocarditis caused by Pseudomonas aeruginosa serotype O11 among pentazocine and tripelennamine abusers in Chicago. J Infect Dis 151(2):203–208

    Article  CAS  PubMed  Google Scholar 

  14. Werner SB, Passaro D, McGee J, Schechter R, Vugia DJ (2000) Wound botulism in California, 1951-1998: recent epidemic in heroin injectors. Clin Infect Dis 31(4):1018–1024. https://doi.org/10.1086/318134

    Article  CAS  PubMed  Google Scholar 

  15. Gehrke T, Alijanipour P, Parvizi J (2015) The management of an infected total knee arthroplasty. Bone Joint J 97-B(10 Suppl A):20–29. https://doi.org/10.1302/0301-620X.97B10.36475

    Article  CAS  PubMed  Google Scholar 

  16. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  17. Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J, Goenaga JI, Arenaza JC (2006) Health-related quality of life and appropriateness of knee or hip joint replacement. Arch Intern Med 166(2):220–226. https://doi.org/10.1001/archinte.166.2.220

    Article  PubMed  Google Scholar 

  18. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  19. Bach CM, Biedermann R, Goebel G, Mayer E, Rachbauer F (2005) Reproducible assessment of radiolucent lines in total knee arthroplasty. Clin Orthop Relat Res 434:183–188

    Article  Google Scholar 

  20. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  21. Bae DK, Song SJ, Park MJ, Eoh JH, Song JH, Park CH (2012) Twenty-year survival analysis in total knee arthroplasty by a single surgeon. J Arthroplast 27(7):1297–1304, e1291. https://doi.org/10.1016/j.arth.2011.10.027

    Article  Google Scholar 

  22. SKAR (2016) Annual report 2016. The Swedish Knee Arthroplasty Register, Helsingborg, Sweden

  23. National Joint Registry (2016). National Joint Registry 13th annual report. Retrieved from http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2013th%20Annual%20Report%202016.pdf

  24. Sendi P, Banderet F, Graber P, Zimmerli W (2011) Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Inf Secur 63(1):17–22. https://doi.org/10.1016/j.jinf.2011.05.005

    Google Scholar 

  25. Shen M, Xiang P, Sun Y, Shen B (2013) Disappearance of 6-acetylmorphine, morphine and codeine from human scalp hair after discontinuation of opiate abuse. Forensic Sci Int 227(1–3):64–68. https://doi.org/10.1016/j.forsciint.2012.10.028

    Article  CAS  PubMed  Google Scholar 

  26. Brown P, Crane L (2001) Avascular necrosis of bone in patients with human immunodeficiency virus infection: report of 6 cases and review of the literature. Clin Infect Dis 32(8):1221–1226. https://doi.org/10.1086/319745

    Article  CAS  PubMed  Google Scholar 

  27. Miller KD, Masur H, Jones EC, Joe GO, Rick ME, Kelly GG, Mican JM, Liu S, Gerber LH, Blackwelder WC, Falloon J, Davey RT, Polis MA, Walker RE, Lane HC, Kovacs JA (2002) High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 137(1):17–25

    Article  PubMed  Google Scholar 

  28. Swensen S, Schwarzkopf R (2012) Total joint arthroplasty in human immunodeficiency virus positive patients. Orthop Surg 4(4):211–215. https://doi.org/10.1111/os.12001

    Article  PubMed  Google Scholar 

  29. Parvizi J, Sullivan TA, Pagnano MW, Trousdale RT, Bolander ME (2003) Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplast 18(3):259–264. https://doi.org/10.1054/arth.2003.50094

    Article  Google Scholar 

  30. Boylan MR, Basu N, Naziri Q, Issa K, Maheshwari AV, Mont MA (2015) Does HIV infection increase the risk of short-term adverse outcomes following total knee arthroplasty? J Arthroplast 30(9):1629–1632. https://doi.org/10.1016/j.arth.2015.03.018

    Article  Google Scholar 

  31. Enayatollahi MA, Murphy D, Maltenfort MG, Parvizi J (2016) Human immunodeficiency virus and total joint arthroplasty: the risk for infection is reduced. J Arthroplast 31(10):2146–2151. https://doi.org/10.1016/j.arth.2016.02.058

    Article  Google Scholar 

  32. Cummins F, Ramasubbu B, McCarthy T, Bergin C, Grieve PP (2015) Surgery of the femur in HIV positive patients: a retrospective review from 2005 to 2011. Ir J Med Sci 184(2):505–510. https://doi.org/10.1007/s11845-014-1156-6

    Article  CAS  PubMed  Google Scholar 

  33. Capogna BM, Lovy A, Blum Y, Kim SJ, Felsen UR, Geller DS (2013) Infection rate following total joint arthroplasty in the HIV population. J Arthroplast 28(8):1254–1258. https://doi.org/10.1016/j.arth.2012.12.021

    Article  Google Scholar 

  34. Ernstbrunner L, Hingsammer A, Catanzaro S, Sutter R, Brand B, Wieser K, Fucentese SF (2016) Long-term results of total knee arthroplasty in haemophilic patients: an 18-year follow-up. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-016-4340-6

  35. Chiang CC, Chen PQ, Shen MC, Tsai W (2008) Total knee arthroplasty for severe haemophilic arthropathy: long-term experience in Taiwan. Haemophilia 14(4):828–834. https://doi.org/10.1111/j.1365-2516.2008.01693.x

    Article  CAS  PubMed  Google Scholar 

  36. Legroux-Gerot I, Strouk G, Parquet A, Goodemand J, Gougeon F, Duquesnoy B (2003) Total knee arthroplasty in hemophilic arthropathy. Joint Bone Spine 70(1):22–32

    Article  PubMed  Google Scholar 

  37. Norian JM, Ries MD, Karp S, Hambleton J (2002) Total knee arthroplasty in hemophilic arthropathy. J Bone Joint Surg Am 84-A(7):1138–1141

    Article  PubMed  Google Scholar 

  38. Wada NI, Jacobson LP, Margolick JB, Breen EC, Macatangay B, Penugonda S, Martinez-Maza O, Bream JH (2015) The effect of HAART-induced HIV suppression on circulating markers of inflammation and immune activation. AIDS 29(4):463–471. https://doi.org/10.1097/QAD.0000000000000545

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland

    David E. Bauer, Andreas Hingsammer, Lukas Ernstbrunner, Alexander Aichmair, Franziska Eckers, Karl Wieser & Sandro F. Fucentese

  2. Department of Orthopedics and Traumatology, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria

    Lukas Ernstbrunner

  3. Department of Radiology, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland

    Andrea B. Rosskopf

Authors
  1. David E. Bauer
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Correspondence to David E. Bauer.

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This study received local ethics committee approval.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Bauer, D.E., Hingsammer, A., Ernstbrunner, L. et al. Total knee arthroplasty in patients with a history of illicit intravenous drug abuse. International Orthopaedics (SICOT) 42, 101–107 (2018). https://doi.org/10.1007/s00264-017-3655-3

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  • DOI: https://doi.org/10.1007/s00264-017-3655-3

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