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Human Immunodeficiency Virus Infection and Hip and Knee Arthroplasty

Dimitriou, Dimitrios MBChB(UCT), FCOrth(SA)1,a; Ramokgopa, Mmampapatla MBChB(Natal), FCS(SA)Ortho, MSc(Med)(Wits)1; Pietrzak, Jurek R.T. MBBCh(Wits), FCOrth(SA)1; van der Jagt, Dick MBBCh(Wits), FCS(SA)1; Mokete, Lipalo MBChB(UCT), FRCS(Eng), FCS(SA)Ortho1

doi: 10.2106/JBJS.RVW.17.00029
Evidence-Based Systematic Reviews
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Update This article was updated on November 13, 2019, because of a previous error. On page 1, in the Results section of the Abstract, the sentence that had read “HIV-positive patients had a significantly elevated risk of periprosthetic joint infection, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43)” now reads “HIV-positive patients had a significantly elevated risk of complications, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43).”

An erratum has been published: JBJS Reviews. 2019 Nov;7(11):e7.

Background: Modern management of human immunodeficiency virus (HIV) infection has afforded patients longevity while increasing the burden of arthroplasty procedures because of the increased risk of osteonecrosis, fragility fractures, and degenerative joint disease. Early publications on hip and knee arthroplasty in HIV-positive patients reported a high risk of complications, although some more recent publications demonstrated acceptable outcomes. Despite the widespread nature of the HIV pandemic, there is a paucity of literature addressing outcomes following joint arthroplasty in infected patients. We pooled available studies to obtain the best evidence regarding the safety of total hip and knee arthroplasty procedures in HIV-positive patients. The studies identified were heterogeneous, precluding a meta-analysis. However, we performed a review of the literature focusing on complications and outcomes.

Methods: Twenty-one published English-language articles involving 6,516,186 joints were identified by a systematic review as suitable for inclusion in the study. The articles were analyzed for complication and prosthesis survivorship rates and relative risks.

Results: An overall complication rate of 3.3% was found across the 19 articles that provided such data. HIV-positive patients had a significantly elevated risk of complications, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43). Eleven articles were suitable for analysis of prosthesis survivorship, and survivorship rates did not differ significantly between HIV-positive and negative patients.

Conclusions: Total hip and total knee arthroplasty appear to be safe procedures with acceptable outcomes in HIV-positive patients.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa

aE-mail address for D. Dimitriou: dimitriosdimitriou@gmail.com

Investigation performed at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), University of the Witwatersrand, Johannesburg, South Africa

Disclosure: No funding was received for this research. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A263).

Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated
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