Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes

Alexandra Baker Lutz; Deepak V Patel; Christopher Bibbo; Ian S Hong; Daniel Hameed; Jeremy Dubin; Michael A Mont

doi:10.1016/j.arth.2024.02.043

Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes

J Arthroplasty. 2024 Mar 5:S0883-5403(24)00143-8. doi: 10.1016/j.arth.2024.02.043. Online ahead of print.

Authors

Alexandra Baker Lutz¹, Deepak V Patel², Christopher Bibbo³, Ian S Hong⁴, Daniel Hameed⁵, Jeremy Dubin⁵, Michael A Mont⁵

Affiliations

¹ University of Maryland Medical Center, Department of Orthopaedic Surgery, Baltimore, MD, U.S.A.
² Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA.
³ International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A.; Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA. Electronic address: cbibbo@lifebridgehealth.org.
⁴ Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJ Barnabas Health, 377 Jersey Ave, Suite 550, Jersey City, New Jersey 07302, U.S.A.
⁵ Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A.

PMID: 38452861
DOI: 10.1016/j.arth.2024.02.043

Abstract

Introduction: Total hip arthroplasty (THA) has become a common intervention for Human Immunodeficiency Virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV.

Methods: A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on two scales: the Coleman Methodology Score and the level of evidence derived from Centre for Evidence-Based Medicine criteria. Data was extracted from studies in the five key areas of interest: survivorships; PROMs; infection rates; complications; as well as clusters of differention-4 (CD4+) counts and viral loads (VL).

Results: Implant survivorship was between 95 and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm³, with low VL (3 reports) and variations not found to influence outcomes.

Conclusion: Total hip arthroplasty (THA) is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications.