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Background:Aseptic necrosis (AN) of bones is one of the most serious complications of systemic lupus erythematosus (SLE), which is characterized by multicomponent joint damage mainly in young people. Long-term observations show that two thirds of patients have multiple aseptic necrosis of bones, with the femoral head being most often affected. Obviously, caused by much strain on the hip joint. In this regard, total hip arthroplasty (THA) is an integral part of the treatment of SLE patients. Despite the fact that THA in these patients allows to achieve good functional outcomes, the amount of complications remains high.Objectives:To retrospectively analyze the outcomes and structure of complications to determine the tactics of perioperative management of patients with SLE.Methods:The retrospective group included patients over 18 years of age with a reliable diagnosis of SLE, established according to the classification criteria (SLICC, 2012, ACR, 1997). 123 THA were performed in 77 patients. Outcomes and the structure of complications were analyzed for the period from 1998 to 2016 inclusive.Results:The period of hospital stay of patients was analyzed. Cementless fixation of the components of the endoprosthesis was used and the friction pair was metal-polyethyleneIn all cases. In 23 patients, additional fixation of the acetabular component with screws was performed, which indirectly indicates a poor quality of bone tissue. A more detailed analysis of these patients revealed a long period of glucocorticoid therapy (from 1.5 to 35 years). In 3 patients, during preparation for implantation of the femoral component, a femoral fracture occurred, which required using the cerclages. One patient also had a fracture of the acetabulum, which required the implantation of a Müller anti-protrusio ring. The above-described technical features led to increasing of the total time of surgery, which significantly increased the volume of blood loss. Thus, this required transfusions of blood components: fresh frozen plasma (FFP), erythrocyte suspension, as well as replenishment the circulating blood volume with colloidal solutions.Prevention of thromboembolism. All patients in the postoperative period underwent common measures of prevention of venous thromboembolism. The drugs of choice were calcium nadroparin (Fraxiparin) 0.3 or 0.6 ml subcutaneously - depending on body weight, respectively, or Dabigatran etexilate (Pradaxa) 220 mg per day, or rivaroxaban (Xarelto) 10 mg per day.Prevention of infectious complications. The first injection of antibiotic is carried out immediately before surgery achieve it’s maximum concentration in blood plasma just in the time of first incision. In the postoperative period, antibiotic therapy was carried out for at least 5 days. In 1 patient, the course of antibiotic therapy was prolonged and another broad-spectrum antibiotic was added due to a history of tuberculosis infection. Postoperative rehabilitation in patients with SLE met standard protocols: activation in bed and verticalization was carried out on day 1, standing with crutches and walking on day 2.Conclusion:During the period of hospital stay in the early postoperative period, not a single one thromboembolic event developed, as well as no cases of infectious complication occurred. There was one case of dislocation of the femoral component of the endoprosthesis, which was immediately repaired in the early postoperative period.Disclosure of Interests:None declared

BackgroundSurgical treatment of patients with rheumatoid arthritis (RA) associated with increased risk of complications. It is caused presence of an inflammatory process, osteoporosis, the reduced physical activity, the severity of functional impairment, long-term glucocorticoid therapy, biologic and disease-modifying antirheumatic drugs. All this contributes to increase the risk of perioperative complications, including non-infectious complications of surgical wounds.ObjectivesTo conduct a comparative analysis of local non-infectious complications of surgical wounds (delayed wound healing, marginal necrosis, wound dehiscence) after total hip and knee arthroplasty in patients with RA and osteoarthritis (OA).MethodsIn the period from 1998 to 2013 in patients with RA and OA was performed 1605 operations of hip replacement surgery (RA - 385, OA - 482) and knee replacement surgery (RA - 527, OA - 211).ResultsThere were 29 (1.81%) local non-infectious complications of wounds.After hip arthroplasty local non-infectious complications of wounds developed in 7 (0,44%) patients, all diagnosed with RA.Local non-infectious complications of the wound after knee arthroplasty was 22 complications, from them - 17 (1.06%) in patients with RA; 5 (0.31%) in patients with OA.Revealed a significantly greater number of local non-infectious complications of surgical wounds after hip and knee arthroplasty in patients with RA (p<0,005).ConclusionsThe results confirm that the surgical treatment of patients with RA, requires a specific approach, which consists in a competent medication administered to the patient with rheumatologist and careful treatment of the bone and surrounding tissues during surgery.Disclosure of InterestNone declared

Surgical treatment in patients with rheumatic diseases (RDs) is associated with the higher risk of complications due to the presence of the inflammatory process, to long-term therapy with glucocorticoids, disease-modifying antirheumatic drugs, and biologic agents (BA), to decreased physical activity, and the severity of functional disorders, and to obvious osteoporosis. All this increases the risk of intraoperative complications, including periprosthetic fractures.Objective: to comparatively analyze intraoperative periprosthetic fractures of the greater trochanter, acetabulum, and proximal femur during total hip arthroplasty (THA) in patients with RDs.Subjects and methods. From 1998 till 2017, a total of 1569 THA were performed in patients with RA, including 464 patients with rheumatoid arthritis (RA), 396 with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), and 709 with osteoarthritis (OA).Results and discussion. Periprosthetic fractures after THA were diagnosed in a total of 68 (4.33%) patients, including 23 (4.96%) patients with RA, 27 (6.82%) with JRA and SLE, and 18 (2.54%) with OA; 42 (61.8%) patients with periprosthetic fractures underwent osteosynthesis. Statistical analysis of the findings revealed significantly higher rates of complications in patients with RA and JRA with SLE (p < 0.005).Conclusion. The findings confirm that the risk of periprosthetic fractures is higher in patients with inflammatory diseases, including RA, JRA, and SLE. These patients require a special approach that involves medical correction of impaired bone metabolism and proper individual selection of endoprosthetic components, by taking into account the anatomical features of female patients and delicate bone handling during surgery.