Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends

Apr 28, 2016Journal of shoulder and elbow surgery

Shoulder Replacement Surgery in People with HIV: Complications, Other Health Conditions, and Trends

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Abstract

A total of 2528 HIV-positive patients underwent total shoulder arthroplasty (TSA) or reverse TSA (RTSA) from 2005 to 2012.

The utilization of TSA and RTSA in HIV-positive patients increased significantly during this period.
Patients undergoing TSA were slightly older and had a higher prevalence of comorbidities, indicating a potentially sicker population.
HIV-positive patients had a markedly increased risk of experiencing a cerebrovascular accident within 90 days post-surgery (odds ratio of 35.98).
Higher rates of complications were observed, including broken prosthetic joints (odds ratio of 1.72) and periprosthetic infections (odds ratio of 1.36).
The likelihood of requiring revision or repair of TSA was also elevated in this group (odds ratio of 2.44).

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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.

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Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends

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