Equivalent Functional Recovery and Radiographic Outcomes in Human Immunodeficiency Virus-Positive and Virus-Negative Patients Undergoing Robot-Assisted Total Knee Arthroplasty.

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 (HIV). However, comparative outcome data in high-prevalence settings remain limited. This study compared perioperative safety, radiographic accuracy, and functional outcomes of RA-TKA in HIV-positive and HIV-negative patients.

METHODS

A prospective observational cohort of 214 consecutive RA-TKAs (2019 to 2021) was analyzed; 203 patients (162 HIV-negative, 41 HIV-positive) completed ≥ 3 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 Knee Society Score (51.9 ± 15.3) and change in visual analog scale (-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.

CONCLUSIONS

An RA-TKA is safe and effective in well-controlled HIV-positive patients, achieving 3-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.