Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive patients—Up to 14 Year Follow-Up

Introduction: With improvements in HIV treatment, patients expect to have increasingly better lifestyles that allow them to be more active and pain free. Unfortunately, HIV and the highly active antiretroviral therapy (HAART) used for its treatment may predispose patients to early degenerative joint changes. Moreover, as patients continue to adhere to these potent therapeutic agents, the need for total joint arthroplasty (THA) within this population will continue to rise. Given this increasing demand, this study sought out to determine if HIV-positive patients undergoing THA can consistently achieve good long-term outcomes.

Methods: We retrospectively reviewed all patients diagnosed with HIV undergoing THA between 1/2000 and 4/2017. Patients with a diagnosis of hemophilia were excluded. Demographics, operative details, as well as preoperative and postoperative clinical and radiographic data was collected. Perioperative complications, readmissions, and revision procedures were compiled. Descriptive stats reported means and standard deviations (SD).

Results: We analyzed data on 41 hips (31 patients), 22 (70%) of which were male and 9 (30%) of which were females. Mean age at surgery was 49.5 years, mean BMI was 26.5, mean ASA score was 2.8, and mean duration of HIV infection was 18.2 years. We recorded follow-up data on 29 (70%) of the hips with a mean follow-up time of 1,461 days (range, 70-5044). Mean estimated blood loss was 520.2 mL (range, 200mL–1500 mL) and 9 (22%) hips required blood transfusions with an average transfusion of 1.4 (range, 1-2) units of packed red blood cells. Postoperative complications included the development of PE in 2 hips (4.8%) and infection in 1 hip (2.4%). Of the 28 hips that were followed-up, 4 (13.7%) required revision surgery.

Conclusion: Our study concludes that it is possible to achieve low incidence of postoperative complications and revision surgery fifteen years following primary THA in non-hemophilic, HIV-positive patients.