With improved treatment for human immunodeficiency virus (HIV), the demand for total knee arthroplasty (TKA) in this population has increased. Studying the relationship between HIV and postoperative complications following TKA will allow orthopaedic surgeons to accurately assess their patients' surgical risk and provide appropriate counseling. This study aims to understand how HIV impacts surgical and medical complications following TKA for osteoarthritis (OA). Patients identified in a national insurance database who underwent TKA for OA from 2010 to 2019 were divided into three cohorts: no HIV, asymptomatic HIV, and acquired immunodeficiency syndrome (AIDS). Univariate and multivariable regression analyses were performed to determine 90-day postoperative complications as well as 2-year surgical complications (revision surgery, prosthetic joint infection, aseptic loosening, and manipulation under anesthesia). A total of 855,373 patients were included, of whom 1,338 had asymptomatic HIV and 268 had AIDS. After multivariable regression analysis, patients with HIV had no difference in 2-year surgical complications relative to the control cohort. Within 90 days postoperatively, patients with asymptomatic HIV had increased odds of arrhythmia without atrial fibrillation and lower odds of anemia. Patients with AIDS had increased odds of anemia and renal failure. Patients with HIV and AIDS are at an increased risk for developing 90-day medical complications and 2-year surgical complications. However, after accounting for their comorbidities, the risk of 90-day complications was only mildly increased and the risk of 2-year surgical complications approximated the control cohort. Surgeons should pay particular attention to these patients' overall comorbidities, which appear to be more closely associated with postoperative risks than HIV status alone. Level of evidence: III.

随着人类免疫缺陷病毒（HIV）治疗的改进，该人群对全膝关节置换术（TKA）的需求有所增加。研究 HIV 与 TKA 术后并发症之间的关系将使骨科医生能够准确评估患者的手术风险并提供适当的咨询。本研究旨在了解 HIV 如何影响骨关节炎 (OA) TKA 后的手术和医疗并发症。国家保险数据库中确定的 2010 年至 2019 年因 OA 接受 TKA 的患者被分为三组：无 HIV、无症状 HIV 和获得性免疫缺陷综合症 (AIDS)。通过单变量和多变量回归分析来确定术后 90 天并发症以及 2 年手术并发症（翻修手术、假体关节感染、无菌性松动和麻醉下操作）。总共纳入了 855,373 名患者，其中 1,338 名无症状艾滋病毒感染者和 268 名艾滋病患者。经过多变量回归分析，HIV 患者与对照组相比，2 年手术并发症没有差异。术后 90 天内，无症状 HIV 患者出现不伴房颤的心律失常的几率增加，贫血的几率降低。艾滋病患者贫血和肾衰竭的几率增加。HIV 和 AIDS 患者发生 90 天医疗并发症和 2 年手术并发症的风险增加。然而，考虑到他们的合并症后，90 天并发症的风险仅略有增加，2 年手术并发症的风险与对照组接近。外科医生应特别注意这些患者的总体合并症，这些合并症似乎比单独的艾滋病毒状况与术后风险更密切相关。证据级别：III。