Total Knee Arthroplasty in Human Immunodeficiency Virus Patients: A Literature Review

• Published in: Arthroplasty today 2024-06, Vol.27, p.101382, Article 101382
• Main Authors: Miller, Asaf, Hameed, Daniel, Dubin, Jeremy, Mont, Michael A., Patel, Deepak V., Bibbo, Christopher, Hong, Ian S.
• Format: Article
• Language: English
• Subjects: Human immunodeficiency virus (HIV); Knee osteonecrosis (ON); Original Research; Outcomes; Total knee arthroplasty (TKA)
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2024.101382

Total knee arthroplasty (TKA) has become a common surgical intervention for human immunodeficiency virus (HIV)-positive patients who develop osteonecrosis of the knee. This paper summarized existing literature regarding the outcomes of HIV-positive patients undergoing TKA in 4 subsections: (1) complications; (2) survivorship analyses; (3) patient-reported outcomes; and (4) infections. A review of PubMed was performed, searching for articles focused on HIV-positive patients undergoing TKA. There were 6 reports selected, containing 4765 HIV-positive patients, and data regarding the various domains was tabulated and analyzed. To ensure article quality, a methodology score and level of evidence were determined for selected studies. Complication rates for HIV-positive patients were low, with a larger study reporting that 7.8% of HIV-positive patients developed a complication in comparison to 8% of HIV-negative patients. Survivorship analyses showed similar results, with a study reporting implant survivorship of 98% for HIV-positive and 99% for HIV-negative patients. There were no differences in patient-reported outcomes; HIV-positive patients improved from baseline with respect to the mean Knee Society objective and mean Knee Society functional scores, and the University of California, Los Angeles self-reported activity levels. The infection rate for HIV-positive patients was low, with a larger database study reporting that 0.6% of HIV-positive patients developed a wound infection in comparison to 0.4% of HIV-negative patients. A TKA is an effective treatment for HIV-positive patients who develop osteonecrosis of the knee. Results showed similar patient-reported outcomes, implant survivorships, revisions, and complication rates when compared to non-HIV patients.