Performing a Safe and Effective Total Hip Arthroplasty on Patients With Inactive or Stably Active Systemic Lupus Erythematosus With Osteonecrosis

Abstract

Introduction: Patients with systemic lupus erythematosus (SLE) are typically treated with total hip arthroplasty (THA) because of osteonecrosis of the femoral head (ONFH). This study evaluated the outcome of THA in this patient group. Methods: From January 2004 to January 2017, we retrospectively studied 92 THAs for patients with SLE and 92 THAs for age- and sex-matched patients suffering from ONFH due to nonrheumatic etiologies Both groups were treated with cementless THA and followed up for an average of 50.9 ± 30.6 months. Their surgical outcomes and complications were evaluated and compared. Results: No significant difference existed in age, sex, weight, height, follow-up time, and Ficat staging between the groups. All patients with SLE were in inactive or stably active disease conditions. For all patients, the Harris hip score (HHS) (from 52.6 to 92.8; P < 0.001), Physical Component Summary Scale score (PCS) (from 29.4 to 49.3; P < 0.001), and Mmental Component Summary Scale score (MCS) (from 50.5 to 55.5; P < 0.001) of the Short Form-12 improved significantly after surgery. At the final follow-up, the HHS and MCS were comparable between the two groups. The PCS remained lower in the SLE group (P = 0.017), and no recorded revision surgieries in either group. Corticosteroid intake and testing positive for antiphospholipid antibodies, rather than having a SLE disease activity index score greater than zero, were risk factors for higher complications. Discussion: Performing THA for patients with SLE in an inactive or stably active disease condition resulted in comparable postoperative HHS and MCS scores, a lower PCS score, and shorter term postoperative complications compared with patients with ONFH resulting from nonrheumatic diseases. Patients with SLE had a higher risk for postoperative complications. It is generally safe and effective to perform THA in patients with inactive or stably active SLE. However, they still have an increased risk of short-term complications.

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

“…Demographics and clinical outcomes were 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 29573 hips in the SLE group were studied compared to 4013027 hips in the non-SLE group.…”

“…Wound infection. The wound infection was used in seven studies [10,11,14,15,17,23,24], and the results in the metaanalysis showed signi cant differences. According to Fig.…”

“…It is worth noting that the result is consistent with the conclusion of Schanzer et al [17] Seroma or hematoma. 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 to 1.33, P=0.32, I2 = 14%)(Figure 2B).…”

“…[3]Some studies have reported several complications of total hip replacement in patients with SLE and postoperative Harris hip scores (HHS) and other functional scoring results. [7][8][9][10][11][12][13][14][15][16] At present, there is no clear consensus on the impact of complications after THA in patients with SLE. Patients with SLE undergoing THA are widely considered to have an increased risk of postoperative complications.…”

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

“…Although it is generally believed that patients with systemic lupus erythematosus could have good final function after THA, controversies remain with regard to whether patients with lupus have more complications after undergoing THA. Some case-control studies have shown that SLE patients have a higher incidence of perioperative complications and longer hospital stay during the perioperative period of total hip arthroplasty than patients with rheumatoid arthritis or osteoarthritis [8][9][10][11][12][13][14]. Some studies have reported that SLE is not an independent risk factor for perioperative adverse events in THA.…”