The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis

• Published in: European journal of orthopaedic surgery & traumatology Vol. 34; no. 4; pp. 1939 - 1944
• Main Authors: Shah, Neil V., Lettieri, Matthew J., Kim, David, Zhou, Jack J., Pineda, Nathaniel, Diebo, Bassel G., Woon, Colin Y. L., Naziri, Qais
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.05.2024; Springer Nature B.V
• Subjects: Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Asymptomatic; Asymptomatic Diseases; Female; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Immune system; Joint surgery; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative period; Propensity Score; Retrospective Studies; Surgical Orthopedics; Traumatic Surgery; Asymptomatic human immunodeficiency virus (AHIV); Total hip arthroplasty (THA); Length of stay (LOS); Complications; Total knee arthroplasty (TKA)
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-024-03872-3

Purpose The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. Methods The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. Results There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p  ≥ 0.081). AHIV patients had longer lengths of stay (4.0 days) than non-HIV patients after both TKA (3.3 days) and THA (3.1 days) ( p  ≤ 0.011). Both TKA groups had similar postoperative complication rates ( p  > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p  = 0.043). AHIV was not associated with increased complications following both procedures. Conclusion Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.