Does systemic lupus erythematosus increase the risk of complications from total hip arthroplasty?

Abstract

Background Patients with systemic lupus erythematosus are more likely to receive THA than the general population. However, it is controversial whether SLE increases the risk of complications from THA. The purpose of this retrospective study was to reassess the risks from THA in patients with SLE under the management model of enhanced recovery after surgery. Methods Patients with systemic lupus erythematosus diagnosed from December 2011 to December 2017 and treated with THA were compared with THA patients with osteoarthritis. The data were extracted from the medical record system of our department. The chi-square test and t-test were used for comparison. Results The postoperative blood loss in patients with SLE was significantly higher than that in the control group, and the postoperative hemoglobin (Hb) and hematocrit (Hct) in the control group were lower than those in the control group (P < 0.05). There was no significant difference in the rate of blood transfusion (9.733 vs 8.133 P = 0.3148) or other complications between the two groups (P > 0.05). Conclusion Well-controlled and well-managed SLE will not increase the risk of complications in THA, but can increase the amount of perioperative blood loss. Therefore, perioperative blood management is still essential in SLE patients.

A systematic review and meta-analysis comparing complications following total hip arthroplasty for systemic lupus erythematosus versus for non-systemic lupus erythematosus

“…Chen et al [ 30 ] found that the disease status of SLE did not significantly increase the risk of perioperative wound infection or PJI by controlling for other confounding factors. This is related to the lower starting preoperative hemoglobin in SLE patients compared to that in the osteoarthritis population as reported [ 14 , 33 ]. And Dorsch [ 34 ] also found that SLE is associated with abnormal platelet aggregation and anticoagulant factor antibodies, thus increasing the risk of perioperative bleeding.…”

“…Demographics and clinical outcomes are summarized in Tables 1 Tables 2 . Among the ten screened citations, seven were the case–control studies [ 7 , 11 , 14 , 15 , 17 , 23 , 24 ], two were retrospective [ 18 , 25 ], and one was cohort studies a study [ 10 ]. A total of 29,573 hips in the SLE group were studied compared to 4,013,027 hips in the non-SLE group.…”

“…The wound infection was used in seven studies [ 10 , 11 , 14 , 15 , 17 , 23 , 24 ], and the results in the meta-analysis showed significant differences. According to Fig.…”

“…Seven studies [ 10 , 11 , 14 , 15 , 17 , 23 , 24 ] compared the rates of seroma or hematoma in patients with SLE versus non-SLE of THA. Meta-analysis of these seven studies, all of which reported unadjusted comparative data, revealed a slightly increased risk of seroma or hematoma of THA in patients with SLE relative to those with non-SLE (OR 1.21 95%, CI 1.09–1.33, P = 0.32, I2 = 14%) (Fig.…”

“…Four studies [ 10 , 14 , 17 , 24 ] provided sufficient information in this meta-analysis. Meta-analysis of these 4 studies shows an increased risk of hip dislocation of THA in patients with SLE than those with Non-SLE (OR 1.94, 95%, CI 1.56–2.42, P = 0.84, I 2 = 0%) (Fig.…”