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

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.