Session Information
Date: Monday, November 9, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: More Systemic Lupus Erythematosus (SLE)
patients are undergoing total knee arthroplasty (TKA) with equivalent benefits
to osteoarthritis (OA) patients. While post-surgical adverse events (AEs) are
increased after total hip arthroplasty, whether a similar increase occurs after
TKA is unknown. This study compares 6-month AEs in SLE and OA.
Methods: Patients enrolled in institutional arthroplasty and
lupus registries who underwent TKA between 2007 and 2014 were eligible for this
retrospective case-control study. SLE patients were identified by ICD-9 code
710.0 and confirmed by chart review. OA controls were matched 2:1 with SLE
cases on age, sex, year, and procedure. TKA for fractures were excluded.
6-month AEs were collected through chart review and a self-report
questionnaire. Baseline characteristics were compared and regression analysis was
performed to determine independent predictors of AE.
Results: 52 SLE TKA were matched to 104 OA. There were no
differences in mean age and sex (See Table 1). There was no difference in the
percentage of SLE vs. OA patients with complete 26-week follow-up (SLE 82.7%
vs. OA 79.6%; p-value=0.65). 38.4% of SLE patients had ≥1 Charlson-Deyo
comorbidity vs. 17.3% of OA (p-value<0.001; SLE not counted as a comorbidity).
Pre- and perioperative “stress-dose” steroid use were increased in SLE (28.8%
vs. 1.9%, p-value<0.001; 30.8% vs. 2.9%, p-value=0.01). Patients who received
stress-dose steroids did not experience more AEs (37.5% of SLE on steroids had
AEs vs. 38.9% SLE no steroids vs. 27.9% OA; p-value=0.40). SLE patients did not
experience more major (SLE 25.0% vs. OA 19.2%; p-value=0.41), minor (SLE 15.4%
vs. OA 10.6%; p-value=0.39), or total (SLE 38.5% vs. OA 27.9%; p-value=0.18)
AEs. In a multiple logistic regression analysis controlling for comorbidities, SLE
was not an independent risk factor for AEs (OR 1.61, 95% CI 0.74-3.50). Comorbidities
were also not significantly associated with AEs when controlling for diagnosis (OR
1.05, 95% CI 0.46-2.39).
Conclusion: Despite increased comorbidities and steroid use,
AEs are not increased in SLE patients after TKA and SLE is not an independent
risk factor for AEs. Stress-dose steroid use does not increase risk of AEs.
These important findings should guide recommendations for TKA in SLE patients.
|
Table 1: Patient Characteristics |
|||
|
|
SLE (n = 52) |
OA (n = 104) |
P value |
|
Age (SD) |
57.9 (14.7) |
58.8 (11.6) |
0.72 |
|
Female, n (%) |
51 (98.1%) |
102 (98.1%) |
0.99 |
|
BMI (SD) |
30.2 (8.3) |
32.4 (8.2) |
0.12 |
|
Unilateral, n (%) |
22 (42.3%) |
50 (48.1%) |
0.87 |
|
Charlson-Deyo Comorbidity, n (%)* |
|
|
0.001 |
|
0 comorbidities |
24 (46.2%) |
86 (82.7%) |
|
|
1-2 comorbidities |
19 (36.5%) |
17 (16.3%) |
|
|
3+ comorbidities |
1 (1.9%) |
1 (1.0%) |
|
|
Diabetes, n (%) |
10 (19.2%) |
13 (12.5%) |
0.26 |
|
Anesthesia Type, n (%) |
|
|
|
|
Neuraxial |
27 (51.9%) |
60 (57.7%) |
0.49 |
|
General |
2 (3.8%) |
1 (1.0%) |
0.26 |
|
Regional |
0 |
1 (1.0%) |
0.99 |
|
Adjunct Block |
25 (48.1%) |
40 (38.5%) |
0.25 |
|
Length of Stay (SD) |
5.4 (1.5) |
5.0 (1.0) |
0.06 |
|
Operative time (SD) |
84.4 (23.6) |
87.6 (23.8) |
0.46 |
|
Coumadin as DVT Prophylaxis, n (%) |
49 (94.2%) |
88 (84.6%) |
0.07 |
|
Pre-Operative Corticosteroid Use, n (%) |
15 (28.8%) |
2 (1.9%) |
<.0001 |
|
Perioperative “Stress-Dose” Steroid Use, n (%) |
16 (30.8%) |
3 (2.9%) |
0.01 |
|
Discharged to Inpatient Rehab, n (%) |
26 (50.0%) |
44 (42.3%) |
0.09 |
|
Weeks of Follow-Up (SD) |
23.2 (6.4) |
22.8 (6.8) |
0.72 |
|
Complete 6 Months (26 weeks) of Follow-Up, n (%) |
43 (82.7%) |
82 (79.6%) |
0.65 |
|
*SLE excluded in comorbidity count; Comorbidity scores were missing in 15.4% of SLE patients. Continuous variables were compared between groups using two-sample Student t-test. Categorical variables were compared between groups using Chi-square or Fisher exact test, as appropriate. Fisher exact test was used when 50% of the cells have expected count less than 5. |
|||
|
Table 2: Adverse Events |
|||
|
|
SLE (n = 52) |
OA (n = 104) |
P value |
|
Major Events |
|
|
|
|
Acute Renal Insufficiency |
0 (0%) |
0 (0%) |
N/A |
|
Arrhythmia |
3 (5.8%) |
4 (3.8%) |
0.69 |
|
Deep Vein Thrombosis |
0 (0%) |
0 (0%) |
N/A |
|
Falls |
1 (1.9%) |
3 (2.9%) |
0.99 |
|
Post-Operative Fracture |
0 (0%) |
1 (1.0%) |
0.99 |
|
Dislocation |
0 (0%) |
0 (0%) |
N/A |
|
Manipulation |
2 (3.8%) |
9 (8.7%) |
0.34 |
|
Additional Surgery (excluding manipulation) |
7 (13.5%) |
6 (5.8%) |
0.13 |
|
Any Major Event |
13 (25.0%) |
20 (19.2%) |
0.41 |
|
Minor Events |
|
|
|
|
Superficial Surgical Site Infection |
3 (5.8%) |
1 (1.0%) |
0.11 |
|
Excessive Surgical Site Drainage |
2 (3.8%) |
4 (3.8%) |
0.56 |
|
Surgical Site Ecchymosis |
1 (1.9%) |
3 (2.9%) |
0.99 |
|
Surgical Site Erythema |
4 (7.7%) |
4 (3.8%) |
0.44 |
|
Spinal Headache |
0 (0%) |
1 (1.0%) |
0.99 |
|
Delayed Wound Healing |
1 (1.9%) |
1 (1.0%) |
0.99 |
|
Any Minor Event |
8 (15.4%) |
11 (10.6%) |
0.39 |
|
Categorical variables were compared between groups using Chi-square or Fisher exact test, as appropriate. Fisher exact test was used when 50% of the cells have expected count less than 5. |
|||
|
Table 3: Adverse Events and Stress-Dose Steroid Use |
|
|||
|
|
SLE Steroid (n = 16) |
SLE No Steroid (n = 36) |
OA (n = 104) |
P-Value |
|
Any AE, n (%) |
6 (37.5%) |
14 (38.9%) |
29 (27.9%) |
0.40 |
|
Any Major AE, n (%) |
4 (25.0%) |
9 (25.0%) |
20 (19.2%) |
0.71 |
|
Number of AEs Experienced, n (%) |
|
|
|
0.37 |
|
0 |
10 (62.5%) |
22 (61.1%) |
75 (72.1%) |
|
|
1 |
5 (31.3%) |
10 (27.8%) |
21 (20.2%) |
|
|
2 |
0 (0%) |
4 (11.1%) |
5 (4.8%) |
|
|
3 |
0 (0%) |
0 (0%) |
2 (1.9%) |
|
|
4 |
1 (6.3%) |
0 (0%) |
1 (1.0%) |
|
|
Categorical variables were compared between groups using Chi-square or Fisher exact test, as appropriate. Fisher exact test was used when 50% of the cells have expected count less than 5. |
|
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To cite this abstract in AMA style:
Fein A, Figgie C, Dodds T, Wright-Chisem J, Parks M, Mandl L, Su E, Salmon JE, Mayman DJ, Lee YY, Figgie MP, Goodman SM. Systemic Lupus Erythematosus Does Not Increase Risk of Adverse Events in the First 6 Months after Total Knee Replacement [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/systemic-lupus-erythematosus-does-not-increase-risk-of-adverse-events-in-the-first-6-months-after-total-knee-replacement/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-lupus-erythematosus-does-not-increase-risk-of-adverse-events-in-the-first-6-months-after-total-knee-replacement/