Hemophilia: the changing role of the orthopedic surgeon in the era of HIV infection.

HIV infection and AIDS have posed additional challenges to the orthopedic surgeon and they are discussed in this paper. The acute hemarthrosis. 1. Undertreatment has resulted in further joint degeneration 2. A hemarthrosis with an unusual pain pattern or an elevated temperature may be a pyarthrosis and aspiration and culture are necessary for diagnosis. This complication was very rare prior to HIV infection. Synovitis. 1. In the past we suggested factor replacement and steroids as the primary method of treatment. The use of steroids may be contraindicated in the HIV positive patient. 2. Radioactive synovectomy should be considered in the immune compromised patient. 3. The risks to the surgical team of arthroscopic synovectomy are discussed. Advanced arthropathy. 1. A late infection rate of 10.4% in HIV positive patients with total knee replacements has changed the indications for this procedure. 2. Lesser procedures such as arthrotomy and osteotomy should be considered. Pseudotumor. 1. The indications for pseudotumor surgery must include an evaluation of the risk-benefit ratio in the patient with HIV infection. 2. The orthopedic surgeon must accept the challenge of stimulating and training his students and residents in the principles of orthopedic care of the person with hemophilia.