Hip Replacement OK for HIV Patients

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Hip replacement surgery is safe for patients living with HIV, according to a new study conducted by researchers at UT Southwestern Medical Center.

Total hip arthroplasty is a common procedure performed most of the time in older adults suffering from osteoarthritis or osteonecrosis, conditions that severely limit mobility and lifestyle choices. Yet many surgeons have been hesitant to perform total hip operations on patients with HIV or AIDS due to concerns about complications, including higher risk of infection, need for revision surgery, and increased length of hospital stay.

“The idea for this study stemmed from my own clinical encounters,” says Senthil Sambandam, M.D., assistant professor of orthopaedic surgery at UT Southwestern (UTSW) Medical Center in Dallas. “As orthopedic surgeons, we see occasionally see patients with HIV who are in need of a total hip replacement. However, most orthopedic surgeons are unsure of the complications, length and cost of care outcomes of this specific patient population. Considering the difficulty encountered by most surgeons in answering these questions based on one’s own small cohort of patients, we decided to look at national databases that can provide us with a larger cohort of these uncommon condition.”

The researchers identified HIV patients using ICD-10 diagnosis code. Preoperative variables analyzed were sex, age, elective versus nonelective, tobacco-use disorder, obesity and diabetes without complications.

Using data from the National Inpatient Sample covering 2016-2019, UTSW researchers identified 504 HIV-positive patients who underwent total hip arthroplasty and compared their postoperative complications to a cohort of 493 HIV-negative patients.

Post-operative medical and surgical outcomes assessed included length of stay, mortality, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, blood loss anemia, blood transfusion, wound dehiscence, periprosthetic fracture, periprosthetic dislocation, periprosthetic mechanical complication, periprosthetic infection, superficial surgical site infection, deep surgical site infection and total incurred charges.

“When we just looked at the unmatched date, it looked like HIV patients had higher complications, cost of care and length of stay,” says Sambandam, who led the study. “However, when we matched the patients’ baseline characteristics, we noticed that the risk of complications was comparable to the non-HIV group. This suggests that other factors present in HIV patients may drive the differences in outcomes, but not the presence of HIV itself.”

The matched analysis clearly showed that the difference in the outcome between the groups noted is related to patients baseline characteristics rather than due to HIV per se.

“Matched data showed the importance of patients’ characteristics and hence surgeons should consider age, sex, race, diabetes and smoking status while making treatment decisions for these patients,” Sambandam says. “Even though this study sheds light on the impact of HIV on outcomes after total hip replacement, it is not possible to match for variables in clinical practice. Hence the findings in the unmatched cohort showing increased complications, cost and length of stay has to be considered while making health care policies and reimbursement decisions.”

The researchers will continue to study this with more long-term follow up studies and prospective studies.

“HIV patients should be considered for total hip replacement based on their baseline characteristics — and not just based on the fact they have HIV,” Sambandam says. “These are important findings because they can help alleviate worries among the medical community about treating a group of patients who are often overlooked.”

The research team also included Varatharaj Mounasamy, M.D., professor of orthopedic surgery; Ashish R. Chowdary, a medical student; and Jack Beale, M.D., and Jack Martinez, M.D., both residents in orthopedic surgery.

The study was part of a larger effort by the Department of Orthopadic Surgery to analyze arthroplasty complications in various subpopulations in support of UTSW’s commitment to the care of marginalized patient populations and equal treatment for every patient.

The results were published in published in the Journal of Clinical Orthopaedics and Trauma in May.