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The Journal of Hip Surgery 2022; 06(03): 097-108
DOI: 10.1055/s-0042-1750050
Original Article

Impact of Human Immunodeficiency Virus on Postoperative Outcomes following Osteonecrosis-Indicated Total Hip Arthroplasty

Amil R. Agarwal 
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Ryan J. Mortman 
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Alex Gu
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Samuel I. Fuller
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Tom G. Pollard
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Joshua C. Campbell
1   Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
,
Gregory J. Golladay
2   Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
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Abstract

Osteonecrosis (ON) of the femoral head in human immunodeficiency virus (HIV)-positive patients is often treated with total hip arthroplasty (THA). The purpose of this study was to determine the effect that HIV positive status and acquired immunodeficiency syndrome (AIDS) have on postoperative complication rates and outcomes in patients with ON treated with THA. Patients who underwent primary ON-indicated THA with a minimum of 2-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those who were HIV-positive and those who were HIV-negative (control). The HIV-positive cohort was further stratified into those with AIDS and those with asymptomatic HIV at the time of THA. Univariate and multivariate analyses were conducted to determine associations between the three cohorts and their 90-day, and 2-year outcomes were each compared with HIV-negative patients. In this study, 1,163 patients were in the HIV-positive cohort and 34,288 were in the HIV-negative cohort. In the HIV-positive cohort, there were significantly higher 90-day rates of renal failure (odds ratio [OR] = 1.874; p < 0.001), pneumonia (OR = 1.682; p = 0.002), and sepsis (OR = 1.975; p < 0.001). The asymptomatic HIV cohort and AIDS cohort followed similar associations as the HIV cohort; however, the AIDS cohort also had significantly higher rate of blood transfusion (OR = 1.692; p = 0.012) and deep vein thrombosis (OR = 1.765; p = 0.036). HIV infection, whether symptomatic or not, and AIDS are associated with a higher risk of short-term complications after THA. Physicians must consider this risk and discuss with their patients to reduce future complications.

Keywords

human immunodeficiency virus - osteonecrosis - avascular necrosis - total hip arthroplasty - postoperative outcomes - complication rates

Declaration

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.




Publication History

Received: 19 October 2021

Accepted: 02 May 2022

Article published online:
12 July 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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