title: Outcomes of total joint arthroplasty in HIV patients.
abstract: BACKGROUND
  Advancement in human immunodeficiency virus (HIV) therapies has increased life expectancy. The need for joint replacement is expected to increase as this population develops degenerative changes from aging and avascular necrosis (AVN). Studies have shown a higher risk of peri-prosthetic joint infections (PJI) in HIV patients. However, these studies include a high percentage of hemophiliacs, which may be a confounding variable. With the advent of highly active anti-retroviral therapy (HAART) and evolving HIV demographics, we hypothesize the rate of PJIs in HIV patients are comparable to the general population.
  
  
  METHODS
  We performed a retrospective cohort study using prospectively collected data from our arthroplasty database. We identified 24 HIV patients that underwent 31 primary hip and one primary knee arthroplasty between July 1, 2000 and September 30, 2012. Mean age was 50 years (range 31-74). Mean follow-up was 14 months (range 1.5-60).
  
  
  RESULTS
  There were no PJIs in our HIV population. All HIV patients were non-hemophiliacs on HAART. Thirty-one total hip arthroplasties (THA) and one total knee arthroplasty were performed. Twenty-one HIV patients underwent THA for AVN. Eight patients had bilateral AVN. One patient needed revision for aseptic loosening. The mean CD4 count was 647 (194-1193). Mean viral load was undetectable in 19 patients and unavailable in five.
  
  
  CONCLUSIONS
  Our HIV population had a lower rate of PJI compared to infection rates in prior literature. Despite our limited patient population, our data suggests that well controlled HIV patients on HAART therapy with undetectable viral loads and CD4 >200 are at similar risk of PJI as the average population.
authors.affiliation: Department of Orthopaedics Jackson Health System/University of Miami.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Falakassa
authors.affiliation: Department of Orthopaedics Jackson Health System/University of Miami.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Department of Orthopaedics Jackson Health System/University of Miami.
authors.forename: Michaela
authors.initials: M
authors.lastname: Schneiderbauer
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005271:Femur Head Necrosis / Q000150:complications / Q000601:surgery*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome