Total Joint Arthroplasty in Immunocompromised Patients: A Matched Pair Analysis for Co-morbidities

Background: The prevalence and demand for total joint arthroplasty (TJA) in patients with Human Immunodeficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV), have steadily increased. However, the relationship between these immunocompromising viruses and perioperative complications such as postoperative infection has yet to be fully established.

Methods: 107 TJAs (48 THAs and 59 TKAs) performed in immunocompromised (IC) patients between 2008 and 2014. Patients were matched based on sex, age, BMI, and operation (TKA vs. THA) to patients who were nonimmunocompromised (N-IC). A cohort of 66 IC patients were also matched with 66 N-IC based on medical comorbidities to assess for medical comorbidities that may increase the risk of infection.
Results: The overall complication rate in the IC group and N-IC groups was 20% (22 patients) and 14.6% (16 patients), respectively, which was not statistically significant (p= 0.34). There were no differences between the two groups in the incidence of deep (n=6; 5.5% vs. n=3; 2.7%; p=0.36) or superficial infections (n=4; 2.1% vs. n=1; 0.9%; p=0.50), or re-admissions (n=12; 11% vs. 14; 12.8%; p=0.80). However, there was a significant difference for re-operation (16 versus 6, p = 0.04). When data was adjusted for co-founding factors for complications, matched for co-morbidities, the rate of infection and re-operation were 7.5% and 4.5% in IC and 9% and 6% in N-IC groups, respectively, which were not statistically significant.

Conclusion: Immunocompromised patients were not at a significant increased risk for perioperative complications, postoperative infections or readmissions, but were associated with a higher risk of re-operation.