The impact of systemic lupus erythematosus on the risk of infection after total hip arthroplasty: a nationwide population-based matched cohort study

Abstract

Background We aimed to assess the impact of systemic lupus erythematosus (SLE) on the risk of infection after total hip arthroplasty (THA). Methods We identified patients undergoing primary THA (1996–2013) in Taiwan National Health Insurance Research Database (NHIRD). Patients were then divided into the SLE and control groups according to the diagnosis of SLE. We used 1:1 propensity score to match the control to the SLE group by age, sex, and comorbidities. The primary outcome was infection, including early and late superficial wound infection and periprosthetic joint infection (PJI). The secondary outcome was in-hospital complications. Results We enrolled 325 patients in each group. In the primary outcome, the incidence of early superficial wound infection and PJI was comparable between the SLE and matched-control group. However, the incidence of late superficial wound infection and PJI in the SLE group was higher than that in matched-control group (11.4% vs. 5.5%, P = 0.01; 5.2% vs 2.2%, P = 0.04, respectively). Furthermore, the SLE group had a higher risk for late superficial wound infection and PJI (hazard ratio = 2.37, 95% confidence interval (CI) 1.35–4.16; HR = 2.74, 95% CI 1.14–6.64, respectively) than the matched-control. Complications other than infection and in-hospital mortality cannot be compared because of very low incidence. Conclusions SLE is a risk factor for developing late superficial wound infection and PJI, but not for early postoperative complications following THA. Clinical presentations should be monitored to avoid misdiagnosis of PJI in SLE patients after THA.

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.…”

“…[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.…”

Clinical and Histological Features of Prosthetic Joint Infections May Differ In Patients With Inflammatory Arthritis and Osteoarthritis

“…3 The risk of PJI after TKA or THA has been reported to be 50-80% higher for patients with in ammatory arthritis (IA) conditions such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). [4][5][6] Epidemiologic studies have identi ed differences in the onset of PJI between osteoarthritis (OA) and RA patients, namely OA patients are at highest risk for PJI within the rst two years of surgery whereas the risk of PJI persists for the life of the implant in RA patients. 7 The increased risk of PJI in IA patients may be related pharmacologic immunosuppression, immune dysregulation, and/or high disease activity.…”