In-hospital complications following total knee and hip arthroplasty in patients with human immunodeficiency virus

Abstract

Total joint arthroplasty (TJA) is a treatment option that has been increasingly preferred in conditions which lead to joint damage such as severe osteoarthritis (OA), rheumatoid arthritis or avascular necrosis (AVN). [1][2][3] Patients with conditions that particularly affect the hip and knee joint experience a considerably impaired quality of life (QoL), [4][5][6] in which two main TJAs, i.e., total hip arthroplasty (THA) and total knee arthroplasty (TKA) are frequently preferred in the treatment of such patients. The number of primary and revision THAs and TKAs performed has been rising each day due to the expanding population and prolonged life span. [3,7,8] In the past, surgeons were not eager to perform such QoL procedures in patients with immune deficiency diseases due to the surgical risks involvedObjectives: This study aims to analyze the in-hospital complication rates in patients with human immunodeficiency virus (HIV) following primary total knee (TKA) and total hip arthroplasty (THA). Patients and methods:This retrospective study included a total of 37 patients including 11 patients undergoing TKA (11 males; mean age: 60.8±16.0 years; range, 48 to 80 years) and 26 patients undergoing THA (23 males, 3 females; mean age: 49.9±11.5 years; range, 35 to 70 years) between January 2010 and December 2019. The patients were evaluated in terms of body mass index (BMI), American Society of Anesthesiology (ASA) scores, preand postoperative blood tests, indications for surgery, operative time, length of hospital stay, and in-hospital complications. Results:The overall in-hospital complication rate following primary TKA (n=2, 18.2%) and THA (n=2, 7.7%) was 10.8%. Following TKA, one patient had deep vein thrombosis and one patient developed acute renal failure. In the THA group, postoperative delirium and trochanteric fracture were noted. Conclusion:The in-hospital complication rates increased in HIV-positive patients following TKA and THA. The risk of complications can be mitigated with the aid of a better interdisciplinary cooperation and thorough surgical planning.

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

“…Akkaya et al. [ 20 ] included 11 HIV-positive patients undergoing unilateral TKA and found that 2 patients experienced complications, with one encountering deep vein thrombosis and the other developing acute renal failure. However, the authors of this review concluded that the increased complication rate of this study in comparison to existing literature was attributed to the elevated age of their cohort (60.8 ± 16 years) [ 20 ].…”

“…No reports of deep periprosthetic infection. Mean preoperative KSS objective score: HIV+:41, HIV−:42 P = .31; Mean preoperative KSS functional score: HIV+:45, HIV−:44 P = .33; Mean postoperative KSS objective score: HIV+:89, HIV−:91 P = .38; Mean postoperative KSS functional score: HIV+:88, HIV−:90 P = .36; Mean preoperative UCLA score: HIV+: 4 HIV−: 4, P = .63; Mean postoperative UCLA score: HIV+: 6 HIV−: 6, P = .54 Akkaya et al., 2022 [ 20 ] IV 11 HIV+ patients To assess complication rate for HIV+ patients undergoing TKA Not reported 2 patients (18.2%) developed complications such as deep vein thrombosis and acute renal failure. Not reported Not reported Lin et al., 2014 [ 21 ] IV 4 HIV+ and 239 HIV− patients Assess outcomes for HIV+ and HIV− patients undergoing TKA No significant difference in Kaplan-Meier survivorship curve between HIV+ and HIV−patients; No significant difference in number of revisions between HIV+ and HIV− patients.…”

HIV/AIDS patients undergoing total knee arthroplasty are at higher risk of acute renal failure and transfusion and incurred higher cost: a propensity-matched database study

“…In our study, the incidence of acute renal failure was higher in the HIV/AIDS group compared to the group without HIV/AIDS. In a retrospective cohort study of, Akkaya et al reported 1 patient out of 11 HIV positive TKA patients developing acute renal failure [ 9 ]. A study by Lin et al has reported the rate of kidney failure in joint replacement patients with HIV/AIDS a higher incidence of acute renal failure in HIV/AIDS patients (4.2%) who underwent joint replacement than in HIV-negative patients (1.6%) [ 10 ].…”

Should we replace the patella during total knee replacement?

“…Joint arthroplasties are the procedure of choice that have been increasingly adopted in conditions leading to joint damage, such as severe osteoarthritis (OA), rheumatoid arthritis, and avascular necrosis. [ 1 - 3 ]…”

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Joint arthroplasties are the procedure of choice that have been increasingly adopted in conditions leading to joint damage, such as severe osteoarthritis (OA), rheumatoid arthritis, and avascular necrosis. [1][2][3] Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella and some never resurface, while others selectively resurface.

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