Robotic-Assisted Total Knee Arthroplasty in HIV-Positive Patients: Precision Surgery for a Changing Epidemic

Osteoarthritis(OA) and Human Immunodeficiency Virus(HIV) infection are two major global health burdens increasingly intersecting in orthopaedic practice. The global HIV-positive population is aging due to effective antiretroviral therapy, leading to a grwoing number of patients presenting with end-stage knee osteoarthritis requiring total knee arthroplasty(TKA). Conventional TKA, while successful in the general population, remains vulnerable to aseptic loosening and periprosthetic joint infection(PJI); complications that may be accelerated in immunocompromised hosts with altered bone biology. Simultaneously, robotic-assisted TKA (RA-TKA) is transforming knee arthroplasty by improving implant alignment, reproducibility and soft-tissue protection. However, no studies have directly evaluated outcomes of RA-TKA in HIV-positive patients.

This narrative review synthesises current data on OA prevalnece, HIV pathophysiology, TKA outcomes, and robotic technology to examine how precision arthroplasty may alleviate or exacerbate risks in this unique and growing population.

This review highlights an aging HIV-positive population with increasing demand for TKA, due to improved management. HIV-positive patients show mixed short- and long-term TKA outcomes. RA-TKA enhances precision but may increase surgical time, infection risk, pin-site sepsis and osteoporotic bone-related fractures. Mitigation of these potential adverse events is essential and surgeons should follow guidelines to reduce risks.

The increasing subpopulation of people living with HIV and requiring TKA needs to be addressed. Strategies to combat complications that are prone to this group need to be highlighted. Advances in treatment strategies have enabled us to address this intersection between HIV and TKA.