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The effect of HIV prevalence, CD4 counts and disease severity on the outcome of total knee arthroplasty for haemophilic arthropathy: a systematic review and meta-analysis

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Abstract

Purpose

End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count.

Methods

A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan–Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV.

Results

Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973–2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5–1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported.

Conclusion

Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies.

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Data and materials availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Trust Librarian Potenza Atiogbe for her expertise with the literature search, and Research Manager Irrum Afzal for her invaluable guidance and support.

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No funds, Grants, or other support was received.

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Authors and Affiliations

  1. Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK

    Howell Fu, Christian Peacock, Deiary Kader, Nick Clement, Vipin Asopa & David Sochart

  2. Faculty of Health, Science, Social Care and Education, Kingston University, Kingston Hill, Kingston upon Thames, Surrey, KT2 7LB, UK

    Chao Wang

  3. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Cres, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK

    Nick Clement

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  1. Howell Fu
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DHS and HF designed the review. HF and CP screened the literature. HF analysed the data and wrote the manuscript. CW performed statistical analysis. NC made substantial contributions to the manuscript. All authors read and approved the final manuscript.

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Correspondence to Howell Fu.

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Fu, H., Peacock, C., Wang, C. et al. The effect of HIV prevalence, CD4 counts and disease severity on the outcome of total knee arthroplasty for haemophilic arthropathy: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 3235–3254 (2023). https://doi.org/10.1007/s00590-023-03586-y

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