No Decrease in Knee Survivorship or Outcomes Scores for Patients With HIV Infection Who Undergo TKA

• Published in: Clinical orthopaedics and related research 2017-02, Vol.475 (2), p.465-471
• Main Authors: Issa, Kimona, Pierce, Todd P., Harwin, Steven F., Scillia, Anthony J., Festa, Anthony, Mont, Michael A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Clinical Research; Conservative Orthopedics; Female; HIV Infections - complications; Humans; Knee; Knee Joint - surgery; Knee Prosthesis; Lentivirus; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - surgery; Prosthesis Failure; Recovery of Function; Reoperation; Retrospective Studies; Retroviridae; Sports Medicine; Surgery; Surgical Orthopedics; Treatment Outcome
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-016-5122-7

Background HIV is prevalent worldwide and numerous patients with this diagnosis ultimately may become candidates for TKA. Although some studies have suggested that complications are more common in patients with HIV who undergo TKA, these studies largely were done before the contemporary era of HIV management; moreover, it is unclear whether patients with HIV achieve lower patient-reported outcome scores or inferior implant survivorship. Questions/purposes We asked whether there were any differences in the outcomes of patients with HIV without hemophilia who undergo TKA compared with a matched control cohort in terms of: (1) patient-reported outcomes; (2) implant survivorship; and (3) complication rates. Methods Forty-five patients with HIV who had undergone 50 TKAs at three institutions with a minimum followup of 4 years between 2005 and 2011 were identified. An additional three patients were lost to followup before the fourth-year annual visit. All patients with HIV underwent thorough preoperative optimization with their primary care physician and infectious disease specialist. There were 31 men and 14 women with a mean age of 57 years and mean followup of 6 years (range, 4–10 years). These patients were compared with a matched cohort of 135 patients (one-to-three ratio) who did not have HIV and who had undergone a primary TKA by the same surgeons during this same period using the same implant. Matching criteria included patient age (within 2 years), BMI (within 2 kg/m 2 ), surgeon performing TKA, followup (within 6 months), minimum followup of 4 years, sex ratio, and primary diagnosis (degenerative joint disease versus osteonecrosis). Approximately 10% of patients in the matching group had not returned for followup after their sixth annual visit. Outcomes evaluated included The Knee Society objective and function scores, University of California, Los Angeles (UCLA) activity scores, overall implant survivorship (free of revision) using Kaplan-Meier analysis, and complications. With the numbers available, there were no differences in preoperative Knee Society score or UCLA activity scores among the cohorts. Results With the numbers available, there were no differences in the mean Knee Society objective scores between patients with HIV (89 ± 11 points) and the matching cohort (91 ± 14 points) (95% CI, −7 to 3; p = 0.38). There were no differences among the Knee Society functional component as well (88 ± 12 points versus 90 ± 13 points; 95% CI, −6 to 2; p =