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A case-control study of elective hip surgery among HIV-infected patients: exposure to systemic glucocorticoids significantly increases the risk

A case-control study of elective hip surgery among HIV-infected patients: exposure to systemic glucocorticoids significantly increases the risk
A case-control study of elective hip surgery among HIV-infected patients: exposure to systemic glucocorticoids significantly increases the risk
Objectives
This was a cross-sectional study with a nested case?control analysis among a cohort of HIV-infected adults aiming to explore the prevalence of and risk factors for elective hip surgery (total hip arthroplasty and resurfacing).

Methods
Cases were identified from the out-patient database of HIV-infected adults attending one tertiary hospital service. For each case, five controls from the same database matched by age, gender and ethnicity were identified. From the case notes, information about demographic factors, HIV factors and risk factors for hip surgery attributable to osteoarthritis or avascular necrosis (body mass index, lipids, alcohol, comorbidities and treatment with oral glucocorticoids) was extracted.

Results
Among the cohort of 1900 HIV-infected out-patients, 13 cases (12 male) who had undergone hip surgery [0.7%; 95% confidence interval (CI) 0.3?1.1%] were identified, with a median age of 47 years. Eleven of the 13 cases (85%) were Caucasian and seven of the 13 were in stage 3 of HIV infection. Fewer of the cases were in the asymptomatic stage of infection compared with controls [odds ratio (OR) for stage 2 or 3 infection 4.0; 95% CI 0.8–18.5]. Ever having used oral glucocorticoids was highly significantly associated with elective hip surgery (OR 44.6; 95% CI 5.7–347.7).

Conclusions
Among this young cohort, the prevalence of elective hip surgery was 0.7%, with the median age at surgery being 47 years. Ever having been exposed to systemic glucocorticoids was highly significantly associated with elective hip surgery, suggesting that the principal mechanism underlying the need for surgery was avascular necrosis. There may be an increased need for elective hip surgery associated with HIV infection.
avascular necrosis, elective total hip replacement, glucocorticoids, hip resurfacing, hiv, osteoarthritis
1464-2662
182-188
Kerr, E.
9753040e-b4ba-456c-9307-c48d3d5829af
Middleton, A.
c58f3eb5-a1ad-4b11-b6d2-1a0b5d76a7df
Churchill, D.
ac7929fc-1ce9-4769-aec9-2c9637bd6cfc
Reading, I.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Kerr, E.
9753040e-b4ba-456c-9307-c48d3d5829af
Middleton, A.
c58f3eb5-a1ad-4b11-b6d2-1a0b5d76a7df
Churchill, D.
ac7929fc-1ce9-4769-aec9-2c9637bd6cfc
Reading, I.
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109

Kerr, E., Middleton, A., Churchill, D., Reading, I. and Walker-Bone, K. (2014) A case-control study of elective hip surgery among HIV-infected patients: exposure to systemic glucocorticoids significantly increases the risk. HIV Medicine, 15 (3), 182-188. (doi:10.1111/hiv.12084). (PMID:24025108)

Record type: Article

Abstract

Objectives
This was a cross-sectional study with a nested case?control analysis among a cohort of HIV-infected adults aiming to explore the prevalence of and risk factors for elective hip surgery (total hip arthroplasty and resurfacing).

Methods
Cases were identified from the out-patient database of HIV-infected adults attending one tertiary hospital service. For each case, five controls from the same database matched by age, gender and ethnicity were identified. From the case notes, information about demographic factors, HIV factors and risk factors for hip surgery attributable to osteoarthritis or avascular necrosis (body mass index, lipids, alcohol, comorbidities and treatment with oral glucocorticoids) was extracted.

Results
Among the cohort of 1900 HIV-infected out-patients, 13 cases (12 male) who had undergone hip surgery [0.7%; 95% confidence interval (CI) 0.3?1.1%] were identified, with a median age of 47 years. Eleven of the 13 cases (85%) were Caucasian and seven of the 13 were in stage 3 of HIV infection. Fewer of the cases were in the asymptomatic stage of infection compared with controls [odds ratio (OR) for stage 2 or 3 infection 4.0; 95% CI 0.8–18.5]. Ever having used oral glucocorticoids was highly significantly associated with elective hip surgery (OR 44.6; 95% CI 5.7–347.7).

Conclusions
Among this young cohort, the prevalence of elective hip surgery was 0.7%, with the median age at surgery being 47 years. Ever having been exposed to systemic glucocorticoids was highly significantly associated with elective hip surgery, suggesting that the principal mechanism underlying the need for surgery was avascular necrosis. There may be an increased need for elective hip surgery associated with HIV infection.

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More information

e-pub ahead of print date: 11 September 2013
Published date: March 2014
Keywords: avascular necrosis, elective total hip replacement, glucocorticoids, hip resurfacing, hiv, osteoarthritis
Organisations: Primary Care & Population Sciences, Human Development & Health

Identifiers

Local EPrints ID: 357063
URI: https://eprints.soton.ac.uk/id/eprint/357063
ISSN: 1464-2662
PURE UUID: 2dba2296-cb4c-4aee-bca4-c031ac144831
ORCID for I. Reading: ORCID iD orcid.org/0000-0002-1457-6532
ORCID for K. Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459

Catalogue record

Date deposited: 01 Oct 2013 15:45
Last modified: 20 Jul 2019 01:11

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Contributors

Author: E. Kerr
Author: A. Middleton
Author: D. Churchill
Author: I. Reading ORCID iD
Author: K. Walker-Bone ORCID iD

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