6. Bone and Joint Infection associated
with HIV/Aids (Immune Suppression) 
Immune suppression seems to produce certain specific problems of interest to Orthopaedic Surgeons. These can be considered as arising spontaneously or in association with surgery.
1. Acute osteomyelitis and septic arthritis
These diseases usually appear in children but may occur in immune-suppressed adults. This may be as a florid septic arthritis, or an ‘idiopathic’ osteomyelitis occurring in one or more long bones of adults. Often atypical and unusual organisms are involved. Severe disease results, exploratory and drainage wounds may fail to heal and amputation may be necessary.
2. Joint effusions (usually of the knee)
Aids may present as a mildly symptomatic joint effusion. Aspiration does not usually reveal anything very specific and management is best handled by physicians.
3. Tuberculosis of the spine (and elsewhere)
This is likely to be florid, and more acute
than in ‘sero-negative’ people. In adults the lumbar spine may
be more often involved than in those without Aids.
4. Orthopaedic operations
A significant proportion of patients with
‘Aids’ are likely to develop ‘acute’ infections
after osteosynthesis of fractures and this must be borne in mind when choosing
between conservative or operative management.
5. Delayed orthopaedic sepsis
Adults are presenting with apparently spontaneous
deep infections one or more years after osteosynthesis or joint replacement.
A patient with a successfully plated and united tibial or other fracture can
present with an acute (or sub-acute) abscess in relation to the implant one
or more years after its insertion. Similarly infected joint prostheses which
have given good service for many months or years may suddenly become infected.
If and when this occurs always think of ‘Aids’.