Human Immunodeficiency Virus Status Does Not Independently Predict 2-Year Complications Following Total Knee Arthroplasty

Urgent Focus on the Surgical Risks of People Living With HIV: A Systematic Review and Meta-Analysis

With the widespread promotion and application of antiretroviral therapy in clinical practice, people living with HIV (PLWH) have the potential to live as long as non-HIV people and the probability of surgery for PLWH has been increasing dramatically. However, the overall postoperative outcome and risk are still unclear. We performed comprehensive and methodical searches in PubMed, Embase, and Web of Science without date and language restrictions. Study outcomes included: (1) cure rate, (2) mortality, (3) reoperation rate, (4) incidence of any postoperative complications, (5) length of stay, and (6) operation duration. NOS scores were employed to evaluate bias risk, while publication bias was assessed using funnel plots and Egger tests. Review Manager version 5.4.1, R version 4.4.1, and Stata version 14.0 were employed to determine quantitative analysis, considering a significance level of p < 0.05. A total of 50 studies were included, involving 54 565 PLWH undergoing surgical treatment. Synthesis analysis showed that the mortality (OR = 1.70, 95% CI: 1.58-1.83, p < 0.00001), reoperation rate (OR = 1.78, 95% CI: 1.36-2.34, p < 0.00001), complication rate (OR = 1.56, 95% CI: 1.26-1.95, p < 0.00001), LOS (OR = 1.63, 95% CI: 1.28-1.99, p < 0.00001), and operation time (OR = 7.37, 95% CI: 1.14-13.59, p = 0.02) were increased in PLWH. However, there was no significant difference in the cure rate compared to the control group (OR = 1.27, 95% CI: 0.90-1.79, p = 0.18). Subgroup analysis showed that complication rates increased again in orthopedic (OR = 1.65, 95% CI: 1.34-2.05, p < 0.00001) and general surgery (OR = 1.72, 95% CI: 1.08-2.74, p = 0.02). However, the type of procedure, publication quality, study type, and patient origin were not sources of complication rate heterogeneity. Meta-regression showed that CD4 count had no effect on complication rate, but the anti-retroviral therapy rate had 34.89% explanatory power. There is an increased risk of postoperative death, reoperation, complications, and prolonged hospital stay and surgical duration in PLWH. However, conducting extensive prospective studies across multiple centers is crucial to validate these findings.

Analysis of revision rates and complication rates among patients undergoing unicompartmental and bicompartmental knee Arthroplasties when compared to Total knee arthroplasty

BACKGROUND

With recent advances in partial knee arthroplasty, there is conflicting data regarding the outcomes and revision rates for bicompartmental knee arthroplasty (BKA) and unicompartamental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA). This study uses national data to compare surgical and medical complications of UKA, BKA, and TKA to aid surgical decision-making.

METHODS

A retrospective cohort analysis was done using the Mariner dataset of the PearlDiver patient records database from 2010-2019. Current Procedural Terminology (CPT) codes were used to identify patients who underwent UKA, BKA, and TKA for a primary indication of osteoarthritis (OA). Univariate and multivariable analyses were performed to determine 1-year and 2-year revision, prosthetic joint infection (PJI), and loosening, 1-year manipulation under anesthesia (MUA), and 90-day postoperative medical complications.

RESULTS

The BKA cohort was found to have higher odds of one and two-year revision compared to UKA and TKA cohorts. Additionally, the UKA cohort had higher odds of one and two-year revision but lower odds of 1-year MUA than the TKA cohort. However, both the BKA and UKA cohorts had lower odds of any 90-day postoperative complications when compared to the TKA cohort.

CONCLUSIONS

Even with modern implants and approaches, our study found that revision rates are highest for BKA followed by UKA and TKA at two years postoperatively. Notably, medical complications were much less common after all partial knee replacement types when compared to TKA. These findings may be used to guide patients in selecting the appropriate surgery to meet their goals and expectations.