Background/Purpose: In patients with systemic lupus erythematosus (SLE), persistent joint activity and treatment with glucocorticoids are associated with musculoskeletal complications, including hip osteonecrosis. About 30% of these patients develop disability and become candidates for surgical treatment. The frequency of total hip arthroplasty (THA) in these patients has increased progressively. The aim of this study was to evaluate postoperative outcomes and potential risk factors for complications after THA in SLE patients in comparison to other inflammatory and non-inflammatory diseases. 

Methods: We performed a retrospective cohort study at a tertiary care center in Mexico City between 1995 and 2013. All patients with SLE (ACR criteria ≥4), who underwent THA were included (n=58). They were compared with a group of patients with rheumatoid arthritis (RA) and other group with osteoarthritis (OA), matched by gender and date of surgery. All surgeries were performed by the same surgical team. The main outcome was frequency of any postoperative complication during follow-up. The assessed complications were: transfusion requirement, hematoma, thrombosis, infections, aseptic loosening and prosthesis dislocation.

Results: We included 174 patients that underwent THA during the study period. The surgical indication was avascular necrosis in most patients with SLE and RA (98%). Univariate analysis revealed that patients with SLE were younger (p<0.001), and had a longer hospitalization (p=0.001), as well as more transfusional requirements (p=0.004). Other variables are shown in Table 1. Global complications in THA in patients with SLE were more prevalent than in the other groups (36% vs 9%, p<0.001). Most of these events occurred during the postoperative hospitalization. After multivariate analysis, risk factors for THA complications were: SLE (HR 2.8, 95%CI 1.2-6.8; p=0.018) and low postoperative hemoglobin (HR 0.77, 95%CI 0.73-0.83; p<0.001). There was a trend towards a higher risk of complications in patients with history of glucocorticoid treatment (p=0.055). Long-term complications after THA were not different among groups.

Conclusion: To our knowledge, this is the largest single-center study regarding the clinical outcomes after THA in SLE patients. Our data suggest that SLE is an independent risk factor for adverse postoperative outcomes, mainly immediate complications. Particular emphasis should be made on attaining optimal postoperative hemoglobin levels after THA in SLE patients. Our data suggest that even though SLE is associated with increased risk of immediate complications, the long term outcome is good enough to offer surgical treatment, such as THA, that will eventually improve quality of life. 

Table 1 Baseline demographic, clinical and laboratory characteristics in patients with total hip arthroplasty

 Values in bold are statistical significant (p <0.05)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/total-hip-arthroplasty-outcomes-a-17-year-experience-in-a-single-center-is-systemic-lupus-erythematosus-a-real-risk-factor-for-adverse-outcomes/