Clinical Outcomes of Total Hip Arthroplasty in HIV-Associated versus Steroid-Induced Osteonecrosis of the Femoral Head: A Propensity Score Matching-Based Retrospective Study

Purpose To compare clinical outcomes after total hip arthroplasty (THA) between patients with HIV-associated osteonecrosis of the femoral head (ONFH) and those with steroid-induced ONFH, and to assess the perioperative performance of standardized occupational protection protocols. Methods This retrospective study consecutively included patients with ONFH who underwent primary THA between January 2018 and January 2026, comprising 31 patients with HIV-associated ONFH and 143 with SONFH. After 1:2 propensity score matching, 25 HIV-ONFH and 50 SONFH patients constituted the matched analytic cohort. Postoperative recovery was assessed using the Harris Hip Score (HHS) and Visual Analog Scale (VAS); perioperative variables, complications, mortality, and occupational exposure events among healthcare personnel were collected from medical records. Results After matching, baseline characteristics were well balanced between the two groups (all absolute standardized mean differences <0.1). Postoperative HHS at the final follow-up improved to 85.92±6.06 in the HIV-ONFH group and 86.80±4.38 in the SONFH group, while postoperative VAS decreased to 1.04±0.84 and 0.88±0.77, respectively. No significant between-group differences were observed in postoperative functional scores, perioperative variables, or postoperative complications. Mortality rates during follow-up were 8.00% in the HIV-ONFH group and 6.00% in the SONFH group (2 and 3 deaths, respectively). No occupational exposure events were documented among healthcare personnel during the study period. Conclusion THA provided satisfactory short- to mid-term clinical outcomes in both HIV-associated and steroid-induced ONFH. Under standardized perioperative management, HIV infection was not associated with detectably worse surgical outcomes in virally suppressed patients with well-preserved immune function, and standardized protective measures were implemented with no documented occupational exposure events.