ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2385

The Presence of Avascular Necrosis in Patients with Systemic Lupus Erythematosus Undergoing Total Knee Arthroplasty is Not Associated with Worse Outcomes

Billy Kim1, Ahmed Deeb1, Douglas Mintz1, Susan Goodman2, Jose Rodriguez2, Mark Figgie2 and Jason Blevins3, 1Hospital for Special Surgery, New York, 2Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, 3Hospital for Special Surgery, New York, NY

Meeting: ACR Convergence 2025

Keywords: , ,

Session Information

Date: Tuesday, October 28, 2025

Title: (2377–2436) Systemic Lupus Erythematosus – Diagnosis, Manifestations, & Outcomes Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Systemic lupus erythematosus (SLE) patients seeking total knee arthroplasty (TKA) may present with secondary avascular necrosis (AVN) of the knee due to high-dose glucocorticoid use. Whether presence of AVN negatively impacts TKA outcomes in this high-risk population has not previously been studied.

Methods: A retrospective analysis of 184 knees (150 patients) with SLE undergoing TKA between 2015 and 2023 at a large academic institution was conducted. The cohort was stratified by the presence of AVN on preoperative X-ray and/or magnetic resonance imaging (MRI) when available. Imaging diagnosis was validated by an experienced musculoskeletal radiologist. Patient characteristics, clinical outcomes, and patient-reported outcome measures (PROMs) were compared between groups using univariable and multivariable analyses. Mean follow-up was 4.1 years (range: 0.1-8.5).

Results: AVN was present in 13% (n=23/184) of SLE knees. Patients with AVN were younger (P< 0.01) and had lower BMI than patients without AVN (P=0.05). Multivariable analyses demonstrated that younger age was associated with increased risk of 90-day readmission (P=0.03) and revision (P< 0.01). There were no significant differences in complication rates or postoperative PROMs between SLE patients with and without AVN (P >0.05). Based on osteonecrosis patterns on MRI, knee AVN was categorized into three sequential classes: I) primarily metadiaphyseal; II) metadiaphyseal with articular extension; III) progression with severe deformity or bone loss.

Conclusion: TKA outcomes in SLE patients with AVN are comparable to those without. Primary cemented implants provide durable results. In advanced stages of knee osteonecrosis, however, judicious preoperative evaluation is warranted, as significant bone deformities and defects may necessitate augments, cones, and/or stems.

Supporting image 1MRI patterns of osteonecrosis in SLE patients with AVN

Disclosures: B. Kim: None; A. Deeb: None; D. Mintz: American College of Radiology, 4, New York State Radiological Society, 4, Society of Skeletal Radiology, 4; S. Goodman: Johnson and Johnson, 2, Novartis, 5, Pfizer, 2; J. Rodriguez: ASS ASC Development Network, LLC, 8, BICMD, 2, 8, Exactech, Inc., 2, 9, HS2, LLC, 8, Joint Effort Administrative Services Organization, 8, Restor3d, 2, 9, Smith & Nephew, 2, 9, Wishbone, 8; M. Figgie: Bone Solutions, Inc, 2, Diffusion Rx, Inc., 1, 8, Enovis, 2, 9, HS2, LLC, 8, Icarus Medical, 8, Joint Effort Administrative Services Organization, 8, Mekanika, Inc., 8, Sylke, Inc., 1, 8, Wishbone Medical, 1, 2, 8, 9; J. Blevins: Globus Medical, 2, LimaCorporate, 2, Smith & Nephew, 2.

To cite this abstract in AMA style:

Kim B, Deeb A, Mintz D, Goodman S, Rodriguez J, Figgie M, Blevins J. The Presence of Avascular Necrosis in Patients with Systemic Lupus Erythematosus Undergoing Total Knee Arthroplasty is Not Associated with Worse Outcomes [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/the-presence-of-avascular-necrosis-in-patients-with-systemic-lupus-erythematosus-undergoing-total-knee-arthroplasty-is-not-associated-with-worse-outcomes/. Accessed .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-presence-of-avascular-necrosis-in-patients-with-systemic-lupus-erythematosus-undergoing-total-knee-arthroplasty-is-not-associated-with-worse-outcomes/