Treatment of infectious nonspecific coxitis in HIV-positive patients using an antibiotic-loaded spacer for the hip joint
Bibliographic record
Abstract
Introduction The fight with nonspecific infection in immunodeficient HIV-infected patients is challenging. There are no standardized treatment protocols yet. The most effective treatment method of purulent coxitis remains two-stage total hip arthroplasty with the first stage of joint resection and implantation of an antibiotic‑loaded cement spacer, and the second stage of total hip replacement. One of the ways to reduce poor results and revision interventions is the development of new types of spacers for treatment of coxitis in patients with HIV infection.The aim of the work is to demonstrate the effectiveness of a new method of surgical treatment of infectious coxitis in HIV-infected patients using an original design of an antibiotic-loaded articulating spacer in two clinical cases. Materials and methods The treatment results of two HIV-positive patients with infectious coxitis, in whom an original two-layer design of an antibiotic-loaded cement spacer based on the individual bacterial sensitivity was applied at the first stage of treatment, were retrospectively evaluated. To study the effectiveness of this method we used the results of the dynamics of pain evaluation according to Visual Analogue Scale (VAS), the functional state of the affected joint using Harris Hip Score (HSS), Western Ontario and McMaster University osteoarthritis Index (WOMAC) scale and radiological data of patients in the early postoperative period and after 12-month follow-up. Results Clinical cases demonstrate positive results of treatment of infectious coxitis associated with HIV infection. Application of the developed spacer design allowed eradication of bacterial infection. As a result of using of the new spacer model with an antimicrobial effect in the first clinical case it was possible to restore the joint function from 35 to 89 HHS points, from 79 to 14 WOMAC points, to reduce the pain syndrome from 7 to 1 VAS point; in the second patient from 32 to 91 HHS points, from 84 to 11 WOMAC points, to reduce the pain syndrome from 6 to 0 VAS points. Discussion Based on scientific reports and our own clinical cases, we hypothesize that in HIV-associated purulent coxitis, one of the main reasons for poor results after two-stage arthroplasty is insufficient local concentration of antimicrobial agents, caused by the imperfect design of traditional cemented spacers. The original spacer design allows for a higher concentration and may become an effective alternative to traditional treatment methods. Conclusion Application of the developed technology of surgical treatment of infectious coxitis in HIV‑positive patients resulted in eradication of infection, reduction of pain syndrome, restoration of the hip joint functionality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".