Complications due to HIV in patients undergoing total joint arthroplasty: A systematic review and meta-analysis

Background: HIV infection in patients undergoing Total joint arthroplasty (TJA) results in adverse postoperative outcomes. However, there are uncertain data regarding the extent of involvement of HIV in TJA and the individual complications associated with it. Therefore, we planned to conduct a systematic review and meta-analysis to assess the risk of HIV in causing complications after TJA.

Methods: Electronic databases such as PubMed, Cochrane, and Google Scholar from inception till May 1, 2023. Studies evaluating complications in HIV-infected patients following TJA were selected. Statistical Analysis was performed through Revman.

Results: A total of 16 studies evaluating 17,974,549 patients were included in the meta-analysis. HIV-infected patients were at increased risk of developing infectious complications (OR 1.82 [1.49, 2.22]; p < 0.00001; I² = 62 %), medical complications (OR 1.85 [1.41, 2.42]; p < 0.00001; I² = 82.8 %) and surgical complications (OR 1.58 [1.38, 1.82]; p < 0.00001; I² = 76 %) following TJA. On subgroup analysis, we found that there was an increased risk of infectious (OR 1.67 [1.19, 2.34]; p = 0.003; I² = 70 %), medical (OR 1.24 [1.03, 1.48]; p = 0.02; I² = 79 %) and surgical complications (OR 1.35 [1.09, 1.67]; p = 0.007; I² = 69 %) following Total knee arthroplasty. As well as there was an increased risk of infectious (OR 1.76 [1.26, 2.46]; p = 0.0001; I² = 0 %), medical (OR 1.54 [1.12, 2.12; p = 0.007; I² = 85 %), and surgical complications (OR 1.50 [1.22, 1.86]; p = 0.0002; I² = 0 %) following Total hip arthroplasty.

Conclusion: HIV-infected patients are at an increased risk of complications following TJA. Knowledge regarding these individual complications will result in better monitoring and post-operative care.