Mid-term results of total hip and total knee arthroplasty in patients with human immunodeficiency virus

With antiretroviral therapy, patients who are human immunodeficiency virus (HIV)-positive are increasingly becoming candidates for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prior reports focus on perioperative complications, but longer-term outcomes remain unclear. The authors specifically analyzed clinical outcomes, perioperative complications, and survivorship free of periprosthetic joint infection (PJI) of THAs and TKAs in HIV-positive patients who had extended follow-up. A total of 21 HIV-positive patients who underwent 29 primary arthroplasties (14 THAs, 15 TKAs) from 1992 to 2012 were retrospectively reviewed. Mean age was 43 years and mean follow-up was 8 years. Mean perioperative CD4 cell count was 450 cells/mL; only 2 patients had perioperative CD4 cell counts less than 200 cells/mL. At mid-term follow-up, THAs and TKAs were reliable in improving function (mean postoperative Harris Hip Score: 87, P<.01; mean postoperative Knee Society Score: 83, P<.01). The rate of perioperative complications was high (17%). Patients with both hemophilia and HIV were at particular risk for complications at 33% (P=.04). Survivorship free of deep PJI was 100% in THAs at 10 years and 93% in TKAs at 10 years. Only 1 (7%) patient (1 TKA), who had a perioperative CD4 cell count of less than 200 cells/ mL, was revised for deep PJI. In HIV-positive patients, both THAs and TKAs are reliable in alleviating pain and improving clinical function at mid-term follow-up. However, HIV-positive patients are at substantial risk of perioperative complications, especially with comorbid hemophilia. With antiretroviral therapy and maintained CD4 cell counts above 200 cells/mL, survivorship free of deep PJI approaches 100%.