Abstract
Objective
Avascular necrosis of the femoral head is one of the most frequently reported complications in patients with systemic lupus erythematosus (SLE) and often requires total hip arthroplasty (THA). Our objective was to analyze the perioperative management, technical problems, clinical outcomes, and complications associated with THA in patients with SLE.
Methods
A total of 28 total hip arthroplasties performed for 24 patients with SLE, including 19 women and 5 men with a mean age of 38.8 years performed from 1998 to 2011 were retrospectively reviewed. SLE disease activity index and ASA class were evaluated preoperatively. WOMAC, HHS, and SF-36 scores were also evaluated in all cases pre- and post-operatively for functional recovery of the hip and health-related quality of life (HRQOL).
Results
The average SLE disease activity index was 3.5 points. Three patients were in ASA class I, 12 class II, and 9 were class III (37.5%). The average duration of follow-up was 67.5 months. None of the patients required a revision, and 3 patients died during the follow-up period. A statistically significant improvement in all scores was found comparing pre- and post-operative conditions (P < 0.001). The complication rate was 11.1% with 2 wound infections and 1 urinary tract infection.
Conclusion
THA is an acceptable method for achieving functional recovery and increasing HRQOL in patients with SLE and ANFH who receive proper perioperative management.
Similar content being viewed by others
References
Zangger P, Gladman DD, Urowitz MB, Bogoch ER (2000) Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol 27(4):919–923
Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (2003) European working party on systemic lupus erythematosus: morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82(5):299–308
Ward MM (2004) Prevalence of physician-diagnosed systemic lupus erythematosus in the United States: results from the third national health and nutrition examination survey. J Womens Health (Larchmt) 13(6):713–718
Manson JJ, Rahman A (2006) Systemic lupus erythematosus. Orphanet J Rare Dis 27:1–6 (Review)
Danchenko N, Satia JA, Anthony MS (2006) Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 15(5):308–318 (Review)
Dubois EL, Cozen L (1960) Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA 174:966–971
Weiner ES, Abeles M (1989) Aseptic necrosis and glucocorticosteroids in systemic lupus erythematosus: a reevaluation. J Rheumatol 16(5): 604-608. Review
Zizic TM, Marcoux C, Hungerford DS, Dansereau JV, Stevens MB (1985) Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus. Am J Med 79(5):596–604
Mont MA, Glueck CJ, Pacheco IH, Wang P, Hungerford DS, Petri M (1997) Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol 24(4):654–662
Mok MY, Farewell VT, Isenberg DA (2000) Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: is there a role for antiphospholipid antibodies? Ann Rheum Dis 59(6):462–467
Nagasawa K, Tada Y, Koarada S, Horiuchi T, Tsukamoto H, Murai K, Ueda A, Yoshizawa S, Ohta A (2005) Very early development of steroid-associated osteonecrosis of femoral head in systemic lupus erythematosus: prospective study by MRI. Lupus 14(5):385–390
Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, Hallet DC, Cook RJ (2001) Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus. J Rheumatol 28(4):761–765
Cheng T, Feng JG, Liu T, Zhang XL (2009) Minimally invasive total hip arthroplasty: a systematic review. Int Orthop 33(6):1473–1481
Baron JA, Barrett J, Katz JN, Liang MH (1996) Total hip arthroplasty: use and select complications in the US medicare population. Am J Public Health 86(1):70–72
Parker MJ, Gurusamy K (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 19:CD001706 (Review). Update in 2010: Cochrane Database Syst Rev 6:CD001706
Takahashi R, Tsutsumi A, Ohtani K, Goto D, Matsumoto I, Ito S, Wakamiya N, Sumida T (2004) Anti-mannose binding lectin antibodies in sera of Japanese patients with systemic lupus erythematosus. Clin Exp Immunol 136(3):585–590
Orban H, Cîrstoiu C, Adam R (2007) Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis. Rom J Intern Med 45(1):123–129 (Review)
Ito H, Matsuno T, Hirayama T, Tanino H, Minami A (2007) Health-related quality of life in patients with systemic lupus erythematosus after medium to long-term follow-up of hip arthroplasty. Lupus 16(5):318–323
Prupas HM, Patzakis M, Quismorio FP Jr (1981) Total hip arthroplasty for avascular necrosis of the femur in systemic lupus erythematosus. Clin Orthop Relat Res 161:186–190
Hanssen AD, Cabanela ME, Michet CJ Jr (1987) Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Joint Surg Am 69(6):807–814
Chong RW, Chong CS, Lai CH (2010) Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties. Int J Rheum Dis 13(3):235–239
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The committee on prognosis studies in SLE. Arthritis Rheum 35(6):630–640
Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67(1):3–9
Keats AS (1978) The ASA classification of physical status—a recapitulation. Anesthesiology 49(4):233–236
Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64(1):17–19
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840
Bellamy N, Goldsmith CH, Buchanan WW, Campbell J, Duku E (1991) Prior score availability: observations using the WOMAC osteoarthritis index. Br J Rheumatol 30(2):150–151
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483
Doria A, Iaccarino L, Ghirardello A, Zampieri S, Arienti S, Sarzi-Puttini P, Atzeni F, Piccoli A, Todesco S (2006) Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 119(8):700–706
Acknowledgments
This work was supported by the National Natural Science Foundation of China (NO. 30872615) and Scientific Fund of Tampere University, Finland (NO. 9J114). We especially thank Dandan Yu (Department of public health, Sun Yat-sen University, Guangzhou, China) for analyzing the data. The authors would also like to thank Peihui Wu and Zixiong Lei (Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, Guangdong, China) for their valuable assistance.
Conflict of interest
No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Yan Kang and Zi-ji Zhang contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kang, Y., Zhang, Zj., Zhao, Xy. et al. Total hip arthroplasty for vascular necrosis of the femoral head in patients with systemic lupus erythematosus: a midterm follow-up study of 28 hips in 24 patients. Eur J Orthop Surg Traumatol 23, 73–79 (2013). https://doi.org/10.1007/s00590-012-0939-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-012-0939-6