JOA - 2026-07-15 - Journal Article
Equivalent Functional Recovery and Radiographic Outcomes in Human Immunodeficiency Virus-Positive and -Negative Patients Undergoing Robot-Assisted Total Knee Arthroplasty.
Senyolo I, Goga N, Elebo N, Mokete L, Sikhauli N, Pietrzak JRT
Topics
Key Takeaway
HIV-positive patients undergoing RA-TKA achieved equivalent 3-year KSS improvement (51.9 ± 15.3) and higher satisfaction (97.6% vs. 91.4%, P=0.021) compared to HIV-negative controls, with zero PJI or revisions in either group.
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Summary
This study asked whether HIV-positive patients undergoing RA-TKA have inferior perioperative safety, alignment accuracy, or functional outcomes compared to HIV-negative patients. A prospective cohort of 203 consecutive RA-TKAs using an imageless robotic platform with standardized ERAS protocol was analyzed at minimum 3-year follow-up. Both groups achieved equivalent KSS improvement, VAS reduction (-7.0 ± 1.6), alignment accuracy, and complication rates, with HIV-positive patients reporting higher satisfaction (97.6% vs. 91.4%, P=0.021) and zero PJI or revisions in either cohort.
Key Limitation
The HIV-positive cohort (n=41) is too small to detect differences in rare but catastrophic outcomes such as PJI, and the study does not report CD4 counts, viral load thresholds, or HAART regimens, preventing identification of which HIV disease parameters define acceptable surgical candidacy.
Original Abstract
BACKGROUND
Robot-assisted total knee arthroplasty (RA-TKA) improves alignment accuracy and soft-tissue preservation, which may be beneficial in biologically vulnerable populations such as people living with human immunodeficiency virus (PLWH). However, comparative outcome data in high-prevalence settings remain limited. This study compared perioperative safety, radiographic accuracy, and functional outcomes of RA-TKA in human immunodeficiency virus (HIV)-positive and -negative patients.
METHODS
A prospective observational cohort of 214 consecutive RA-TKAs (2,019 to 2,021) was analyzed; 203 patients (162 HIV-negative, 41 HIV-positive) completed ≥ three years of follow-up. All procedures utilized an imageless robotic platform with a standardized surgical and enhanced recovery protocol. Functional outcomes such as Knee Society Score (KSS), Visual Analog Scale (VAS), Timed Up and Go (TUG) test, range of motion, radiographic alignment, complications, and patient satisfaction were compared between groups.
RESULTS
Operative time, blood loss, alignment accuracy, soft-tissue releases, and rehabilitation milestones were similar between groups (all P > 0.05). Both cohorts demonstrated meaningful and comparable improvements in functional outcomes, including change in KSS (51.9 ± 15.3) and change in VAS (-7.0 ± 1.6). Overall satisfaction was high (92.6%), with higher satisfaction among HIV-positive patients (97.6 versus 91.4%; P = 0.021). There were no periprosthetic joint infections, wound complications, mechanical failures, or revisions that occurred.
CONCLUSION
A RA-TKA is safe and effective in well-controlled HIV-positive patients, achieving three-year outcomes and complication rates comparable to those of HIV-negative individuals. Viral suppression and nutritional status appear more relevant than HIV status alone in perioperative risk assessment.