Total joint arthroplasty in immunocompromised patients: a matched pair analysis for comorbidities

Background: The prevalence and demand for total joint arthroplasty (TJA) in patients with human immunodeficiency virus (HIV) and hepatitis C (HCV) have steadily increased. However, the relationship between these immunocompromising viruses and perioperative complications such as postoperative infection has yet to be fully established. Methods: TJA was performed in 109 immunocompromised (IC) patients (50 THAs and 59 TKAs) between 2008 and 2014. Patients were matched based on sex, age, body mass index, and operation (TKA vs. THA) to patients who were nonimmunocompromised (N-IC). A cohort of 66 IC patients were also matched with 66 N-IC based on medical comorbidities to assess for medical comorbidities that may increase the risk of infection. Results: The overall complication rate in the IC group and N-IC groups was 20% (22 patients) and 14.6% (16 patients), respectively, which was not statistically significant (P=0.34). There were no differences between the two groups in the incidence of deep (n=6; 5.5% vs. n=3; 2.7%; P=0.36) or superficial infections (n=4; 2.1% vs. n=1; 0.9%; P=0.50), or re-admissions (n=12; 11% vs. 14; 12.8%; P=0.80). However, there was a significant difference for reoperation (16 vs. 6, P=0.04). When data were adjusted for confounding factors for complications, matched for comorbidities, the rate of infection and reoperation were 7.5% and 4.5% in IC and 9% and 6% in N-IC groups, respectively, which were not statistically significant. Conclusions: IC patients were not at a significant increased risk for perioperative complications, postoperative infections, or readmissions, but they were at higher risk of reoperation.