Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends.
BACKGROUND
Patients with human immunodeficiency virus (HIV) infection were previously at substantial risk for immunosuppression-related complications. As a result of highly active antiretroviral therapy, HIV-infected patients are living longer and are presenting for elective surgery. Outcomes in HIV-infected patients are well described for hip and knee arthroplasty but not for total shoulder arthroplasty (TSA). The purpose of this study was to examine postoperative complications of TSA in HIV-positive patients.


METHODS
We queried the entire 2005 to 2012 Medicare database. Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify the procedure, demographics, comorbidities, and postoperative complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.


RESULTS
The query returned 2528 HIV-positive patients who underwent TSA or reverse TSA (RTSA). There was increased utilization of TSA and RTSA in this population from 2005 to 2012; 1353 patients had 2-year follow-up. These patients were slightly older and had higher prevalence of comorbidities, suggesting a sicker cohort. HIV-positive patients had alarmingly higher rates of 90-day cerebrovascular accident (OR, 35.98; CI, 30.34-42.67). HIV-positive patients had higher overall rates of broken prosthetic joints (OR, 1.72; CI, 1.20-2.47), periprosthetic infection (OR, 1.36; CI, 1.01-1.82), and TSA revision or repair (OR, 2.44; CI, 1.81-3.28).


CONCLUSIONS
To our knowledge, this is the first study that directly examines the postoperative outcomes of HIV-positive patients after TSA or RTSA. As more of these patients present for surgery, surgeons should be aware that these patients might be at increased risk for certain postoperative surgical and medical complications.
Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA. Electronic address: abirambala@gmail.com.
Abiram
A
Bala
Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.
Colin T
CT
Penrose
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Julia D
JD
Visgauss
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Thorsten M
TM
Seyler
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Timmothy R
TR
Randell
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Michael P
MP
Bolognesi
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Grant E
GE
Garrigues
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D000072228:Arthroplasty, Replacement, Shoulder; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D012785:Shoulder Joint / Q000601:surgery; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology
AIDS; HIV; Total shoulder arthroplasty; cerebrovascular accident; complications; outcomes; reverse total shoulder arthroplasty