Outcomes of Total Knee Arthroplasty in Human Immunodeficiency Virus-Positive Patients

Background: Successful treatments for HIV have lengthened the life expectancy of HIV-positive patients; consequently, more HIV-positive patients are candidates for total knee arthroplasty (TKA). This study seeks to provide detailed results of TKA in HIV-positive patients by examining hospital length-of-stay, medical and surgical complications, and infection rates.

Methods: We performed a retrospective analysis on 21 patients undergoing 31 TKAs between 2004 and 2017. Data was analyzed by knee. HIV infection and surgical outcome information was abstracted. Descriptive analysis was conducted on all variables using SPSS v23.

Results: Prior to undergoing TKA, all 31 patients had a documented history of HIV infection. The average CD4+ T-cell count and viral load was 819.73 cells/mm³ (SD, 852.33 cells/mm³) and 3,772.50 copies/mL (SD, 14,799.03 copies/mL), respectively. Before surgery, twenty nine of the patients were on HAART (93.55%). The average length of stay was 3.61 days (SD, 2.28 days). Post-operative complications included acute wound drainage (19.35%), deep venous thrombosis (3.23%), mechanical fall (3.23%), general infection (6.45%), post-surgery blood transfusion (3.23%), and peri-prosthetic joint infection (6.45%). In total, reoperation was required in 5 of 31 knees (16.13%), 3 of which were revision TKA. The average follow-up time was 26.57 months. The CD4+ T-cell counts of the patients who developed a postoperative infection was not significantly different non-infected patients (p = 0.2966). The infected group’s average viral load was undetectable; the non-infected group’s was 4,311.43 copies/mL (SD, 15,817.80 copies/mL).

Conclusion: As the life expectancy for HIV-positive patients continues to improve, a greater number of these patients will be candidates for TKA. This study has identified the frequency of postoperative complications, infections, and revisions in an HIV-positive patient population undergoing TKA, demonstrating that TKA can successfully be performed on HIV-positive patients, however infection, complication, and revisions are moderately elevated compared to historical norms.