Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty - A propensity matched cohort study

Ashish R Chowdary; Vishaal Sakthivelnathan; Jack Beale; Jack Martinez; Varatharaj Mounasamy; Senthil Sambandam

doi:10.1016/j.jcot.2023.102168

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty - A propensity matched cohort study

J Clin Orthop Trauma. 2023 May 12:40:102168. doi: 10.1016/j.jcot.2023.102168. eCollection 2023 May.

Authors

Ashish R Chowdary¹, Vishaal Sakthivelnathan², Jack Beale³, Jack Martinez³, Varatharaj Mounasamy^{3

4}, Senthil Sambandam^{3

4}

Affiliations

¹ University of Texas Southwestern Medical Center, Dallas, TX, USA.
² University of Texas Medical Branch, Galveston, TX, USA.
³ Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
⁴ Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.

Abstract

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population. In this study, we used a national database to evaluate postoperative outcomes in HIV patients undergoing THA compared to THA patients without HIV. We use a propensity algorithm to create a cohort of 493 HIV negative patients for matched analysis. Among the 367,894 THA patients included in this study, 367,390 patients were HIV negative and 504 were HIV positive. The HIV cohort had a lower mean age (53.34 vs 65.88, p < 0.001), lower proportion of females (44% vs 76.4%, p < 0.001), lower incidence of diabetes without complications (5% vs 11.1%, p < 0.001) and a lower incidence of obesity (0.544 vs 0.875, p = 0.002). In the unmatched analysis, the incidence of acute kidney injury (4.8% vs 2.5%, p = 0.004), pneumonia (1.2% vs 0.2%, p = 0.002), periprosthetic infection (3.6% vs 1%, p < 0.001), and wound dehiscence (0.6% vs 0.1%, p = 0.009) were higher in HIV cohort, most likely due to inherent demographic variances present in the HIV population. In the matched analysis, the rates of blood transfusion (5.0% vs 8.3%, p = 0.041) were lower in the HIV cohort. Other post-operative variables, such as rates of pneumonia, wound dehiscence, and surgical site infections were not statistically significant between the HIV positive population and HIV negative matched cohort. Our study found similar rates of postoperative complications in HIV positive and HIV negative patients. The rate of blood transfusions in HIV positive patients was also noted to be lower. Our data suggests that THA is a safe procedure in patients infected with HIV.