J Knee Surg 2020; 33(08): 754-761
DOI: 10.1055/s-0039-1684011
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Mackenzie A. Roof
1   Department of Orthopaedic Surgery, NYU Langone Health, New York
,
Afshin A. Anoushiravani
2   Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
,
Kevin K. Chen
3   Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York
,
Michael J. Moses
1   Department of Orthopaedic Surgery, NYU Langone Health, New York
,
Theodore Wolfson
1   Department of Orthopaedic Surgery, NYU Langone Health, New York
,
Lazaros Poultsides
1   Department of Orthopaedic Surgery, NYU Langone Health, New York
,
Ran Schwarzkopf
1   Department of Orthopaedic Surgery, NYU Langone Health, New York
› Author Affiliations
Further Information

Publication History

18 August 2018

18 February 2019

Publication Date:
08 April 2019 (online)

Abstract

Successful management of human immunodeficiency virus (HIV) has lengthened the life expectancy of HIV-positive (HIV + ) patients; consequently, increasing numbers of this patient population are candidates for total knee arthroplasty (TKA). This study seeks to provide detailed results of TKA in HIV+ patients and compare them to an HIV-negative (HIV − ) cohort. We performed a multicenter retrospective case–control study comparing 25 HIV+ patients to 25 HIV− patients undergoing TKA. The analysis included a cohort and subgroup stratification based on the presence or absence of postoperative complications. Prior to TKA, all 25 patients had a documented history of HIV infection. No intraoperative complications were reported. Ninety-day postoperative complications included knee contracture (one HIV + , no HIV − , p = 0.3124), periprosthetic joint infection requiring revision (one HIV + , no HIV − , p = 0.3124), mechanical fall requiring incision and drainage (one HIV + , no HIV − , p = 0.3124), and death (one HIV + , no HIV − , p = 0.3124). The average follow-up was 18.80 months. HIV+ patients stayed in the hospital for an average of 3.8 days following surgery, which was significantly greater than HIV− patients (2.28 days; p = 0.0040). As the life expectancy for HIV+ patients improves, a greater number will be TKA candidates. This study has shown an acceptable postoperative complication risk in an HIV+ patient population undergoing TKA, albeit with a significantly increased hospital length of stay.

 
  • References

  • 1 Antiretroviral Therapy Cohort C; Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 2017; 4 (08) e349-e356
  • 2 CDC. HIV/AIDS basic statistics. Available at: https://www.cdc.gov/hiv/basics/statistics.html . Accessed July 25, 2017
  • 3 HIV surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas. Volume 26. 2014.Centers for Disease Control and Prevention;2014. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf . Accessed February 28, 2019
  • 4 Lawrence RC, Felson DT, Helmick CG. , et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
  • 5 Murphy L, Schwartz TA, Helmick CG. , et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 2008; 59 (09) 1207-1213
  • 6 Lin CA, Kuo AC, Takemoto S. Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg Am 2013; 95 (11) 1028-1036
  • 7 Takhar SS, Hendey GW. Orthopedic illnesses in patients with HIV. Emerg Med Clin North Am 2010; 28 (02) 335-342
  • 8 Arnsten JH, Freeman R, Howard AA, Floris-Moore M, Lo Y, Klein RS. Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection. AIDS 2007; 21 (05) 617-623
  • 9 Tebas P, Powderly WG, Claxton S. , et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000; 14 (04) F63-F67
  • 10 Mehta P, Nelson M, Brand A, Boag F. Avascular necrosis in HIV. Rheumatol Int 2013; 33 (01) 235-238
  • 11 Allison GT, Bostrom MP, Glesby MJ. Osteonecrosis in HIV disease: epidemiology, etiologies, and clinical management. AIDS 2003; 17 (01) 1-9
  • 12 Morse CG, Mican JM, Jones EC. , et al. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis 2007; 44 (05) 739-748
  • 13 Tehranzadeh J, Ter-Oganesyan RR, Steinbach LS. Musculoskeletal disorders associated with HIV infection and AIDS. Part II: non-infectious musculoskeletal conditions. Skeletal Radiol 2004; 33 (06) 311-320
  • 14 Govender S, Harrison WJ, Lukhele M. Impact of HIV on bone and joint surgery. Best Pract Res Clin Rheumatol 2008; 22 (04) 605-619
  • 15 From the Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA 1993; 269 (06) 729-730
  • 16 Parvizi J, Zmistowski B, Berbari EF. , et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
  • 17 Younai FS. Thirty years of the human immunodeficiency virus epidemic and beyond. Int J Oral Sci 2013; 5 (04) 191-199
  • 18 Astuti N, Maggiolo F. Single-tablet regimens in HIV therapy. Infect Dis Ther 2014; 3 (01) 1-17
  • 19 Gueler A, Moser A, Calmy A. , et al; Swiss HIV Cohort Study, Swiss National Cohort. Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population. AIDS 2017; 31 (03) 427-436
  • 20 Hicks JL, Ribbans WJ, Buzzard B. , et al. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg Br 2001; 83 (07) 1050-1054
  • 21 Ragni MV, Crossett LS, Herndon JH. Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected hemophiliacs with CD4 counts < or = 200/mm3. J Arthroplasty 1995; 10 (06) 716-721
  • 22 Parvizi J, Sullivan TA, Pagnano MW, Trousdale RT, Bolander ME. Total joint arthroplasty in human immunodeficiency virus-positive patients: an alarming rate of early failure. J Arthroplasty 2003; 18 (03) 259-264
  • 23 Falakassa J, Diaz A, Schneiderbauer M. Outcomes of total joint arthroplasty in HIV patients. Iowa Orthop J 2014; 34: 102-106
  • 24 Boylan MR, Basu N, Naziri Q, Issa K, Maheshwari AV, Mont MA. Does HIV infection increase the risk of short-term adverse outcomes following total knee arthroplasty?. J Arthroplasty 2015; 30 (09) 1629-1632
  • 25 Habermann B, Eberhardt C, Kurth AA. Total joint replacement in HIV positive patients. J Infect 2008; 57 (01) 41-46
  • 26 Naziri Q, Boylan MR, Issa K, Jones LC, Khanuja HS, Mont MA. Does HIV infection increase the risk of perioperative complications after THA? A nationwide database study. Clin Orthop Relat Res 2015; 473 (02) 581-586
  • 27 Graham SM, Lubega N, Mkandawire N, Harrison WJ. Total hip replacement in HIV-positive patients. Bone Joint J 2014; 96-B (04) 462-466
  • 28 Issa K, Naziri Q, Rasquinha V, Maheshwari AV, Delanois RE, Mont MA. Outcomes of cementless primary THA for osteonecrosis in HIV-infected patients. J Bone Joint Surg Am 2013; 95 (20) 1845-1850
  • 29 Issa K, Pierce TP, Harwin SF, Scillia AJ, Festa A, Mont MA. No decrease in knee survivorship or outcomes scores for patients with hiv infection who undergo TKA. Clin Orthop Relat Res 2017; 475 (02) 465-471
  • 30 Snir N, Wolfson TS, Schwarzkopf R. , et al. Outcomes of total hip arthroplasty in human immunodeficiency virus-positive patients. J Arthroplasty 2014; 29 (01) 157-161
  • 31 Enayatollahi MA, Murphy D, Maltenfort MG, Parvizi J. Human immunodeficiency virus and total joint arthroplasty: the risk for infection is reduced. J Arthroplasty 2016; 31 (10) 2146-2151
  • 32 Yang B, Yu JK, Gong X. , et al. Sex, age, and annual incidence of primary total knee arthroplasty: a university affiliated hospital survey of 3118 Chinese patients. Chin Med J (Engl) 2012; 125 (22) 3952-3955
  • 33 HIV among men in the United States. 2017. Available at: https://www.cdc.gov/hiv/group/gender/men/index.html . Accessed November 7, 2017
  • 34 Harrison WJ, Lewis CP, Lavy CB. Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study. Injury 2004; 35 (09) 852-856
  • 35 Newman JM, Szubski CR, Barsoum WK, Higuera CA, Molloy RM, Murray TG. Day of surgery affects length of stay and charges in primary total hip and knee arthroplasty. J Arthroplasty 2017; 32 (01) 11-15
  • 36 Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23 (07) 984-991
  • 37 Jämsen E, Varonen M, Huhtala H. , et al. Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty 2010; 25 (01) 87-92
  • 38 Dimitriou D, Ramokgopa M, Pietrzak JRT, van der Jagt D, Mokete L. Human Immunodeficiency Virus Infection and Hip and Knee Arthroplasty. JBJS Rev 2017; 5 (09) e8
  • 39 Elmallah RD, Cherian JJ, Robinson K, Harwin SF, Mont MA. The effect of comorbidities on outcomes following total knee arthroplasty. J Knee Surg 2015; 28 (05) 411-416
  • 40 López-de-Andrés A, Hernández-Barrera V, Martínez-Huedo MA, Villanueva-Martinez M, Jiménez-Trujillo I, Jiménez-García R. Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty. PLoS One 2017; 12 (08) e0183796
  • 41 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
  • 42 Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013; 95 (09) 775-782
  • 43 Lee QJ, Mak WP, Wong YC. Risk factors for periprosthetic joint infection in total knee arthroplasty. J Orthop Surg (Hong Kong) 2015; 23 (03) 282-286
  • 44 Chalmers BP, Abdel MP, Taunton MJ, Trousdale RT, Pagnano MW. Mid-term results of total hip and total knee arthroplasty in patients with human immunodeficiency virus. Orthopedics 2017; 40 (04) e699-e702
  • 45 Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466 (07) 1710-1715