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Equivalent Functional Recovery and Radiographic Outcomes in Human Immunodeficiency Virus-Positive and -Negative
Innocent Senyolo1, Nabila Goga2, Nnenna Elebo1
1Department of Orthopaedic Surgery, Arthroplasty Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Division of Orthopaedic Surgery, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
Robot-assisted total knee arthroplasty (RA-TKA) is safe and effective for people living with HIV (PLWH). Outcomes and complication rates were comparable to HIV-negative patients, showing RA-TKA benefits for this population.
Area of Science:
- Orthopedic Surgery
- Robotic Surgery
- Infectious Diseases
Background:
- Robot-assisted total knee arthroplasty (RA-TKA) offers improved precision and tissue preservation.
- Biologically vulnerable populations, including people living with human immunodeficiency virus (PLWH), may benefit from RA-TKA.
- Limited comparative outcome data exists for RA-TKA in high-prevalence HIV settings.
Purpose of the Study:
- To compare perioperative safety, radiographic accuracy, and functional outcomes of RA-TKA in HIV-positive and HIV-negative patients.
- To evaluate the effectiveness of RA-TKA in a vulnerable patient population.
Main Methods:
- A prospective observational cohort study of 214 RA-TKAs was conducted between 2019 and 2021.
- 203 patients (41 HIV-positive, 162 HIV-negative) with at least three years of follow-up were analyzed.
- An imageless robotic platform, standardized surgical protocols, and enhanced recovery were used. Functional outcomes, radiographic alignment, and complications were compared.
Main Results:
- No significant differences were observed in operative time, blood loss, alignment accuracy, or rehabilitation milestones between HIV-positive and HIV-negative groups.
- Both groups showed comparable improvements in functional outcomes, including Knee Society Score (KSS) and Visual Analog Scale (VAS).
- Overall patient satisfaction was high (92.6%), with significantly higher satisfaction reported by HIV-positive patients (97.6% vs. 91.4%; P = 0.021). No major complications like infections or revisions occurred.
Conclusions:
- RA-TKA is a safe and effective procedure for well-controlled HIV-positive patients, yielding comparable three-year outcomes to HIV-negative individuals.
- Viral suppression and nutritional status are key factors in perioperative risk assessment for HIV-positive patients undergoing RA-TKA.
- RA-TKA demonstrates successful application in biologically vulnerable populations, challenging previous assumptions about surgical risk in PLWH.
