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Case Reports in Infectious Diseases
Volume 2011, Article ID 935041, 5 pages
http://dx.doi.org/10.1155/2011/935041
Case Report

Nonsurgical Management of Severe Osteonecrosis of the Knee in an HIV-Positive Patient: A Case Report

1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7
2International Centre for Disability and Rehabilitation (ICDR), 160-500 University Avenue, Toronto, ON, Canada M5G 1V7
3Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
4School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, Canada L8S 1C7
5Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada M5T 1W7
6Department of Medicine, HIV Clinical Research Unit, Sunnybrook Health Sciences Center, 406-235 Danforth Avenue, Toronto, ON, Canada M4K 1N2

Received 18 May 2011; Accepted 7 June 2011

Academic Editors: K. Como-Sabetti, E. M. Stringer, and P. O. Sumba

Copyright © 2011 Stephanie A. Nixon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Due to the life-prolonging effects of combination antiretroviral therapy, many people with HIV are living longer. However, this enhanced longevity is often mirrored by increased disability resulting from HIV and/or the adverse effects of medication. Management of HIV-positive patients is further complicated by comorbidities related to aging, including bone and joint disorders. In this paper, we describe the nonsurgical management of an HIV-positive patient with premature onset of severe osteonecrosis of the knee. A 50-year-old man who had been HIV-positive for 16 years and on combination antiretroviral therapy for 11 years presented to his family physician with extreme discomfort in his right knee. He was diagnosed with osteonecrosis of the right knee, but resisted total knee arthroplasty because of potential complications under anesthesia related to comorbid advanced liver disease. Instead, a successful combination of non-surgical management strategies was employed by the patient and his health care team.