Skip to main content
Top

21-07-2016 | Systemic lupus erythematosus | Review | Article

Current Perspectives on Arthroplasty in Systemic Lupus Erythematosus: Rates, Outcomes, and Adverse Events

Journal: Current Rheumatology Reports

Authors: Shanthini Kasturi, Susan Goodman

Publisher: Springer US

Abstract

Systemic lupus erythematosus (SLE) is a chronic debilitating condition with significant impact on the musculoskeletal system. Arthroplasty may be indicated for damage related to active lupus or its treatment. As therapies for SLE have advanced, morbidity and mortality have declined, while the rate of joint replacement has increased. The age of SLE patients undergoing arthroplasty is increasing, and the indication for surgery is evolving—while avascular necrosis was previously the predominant indication for arthroplasty, osteoarthritis now accounts for a larger proportion of surgeries. Pain and functional outcomes of arthroplasty in SLE patients are comparable to those of the general population with osteoarthritis, but lupus remains an independent risk factor for post-hip arthroplasty complications and mortality. Further research is needed to characterize the impact of lupus disease activity and severity on arthroplasty outcomes.
Literature
1.
Cervera R, Khamashta M, Font J, et al. 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). 2003;82(5):299–308.CrossRef
2.
Petri M. Musculoskeletal complications of systemic lupus erythematosus in the Hopkins Lupus Cohort: an update. Arthritis Care Res. 1995;8(3):137–45.CrossRefPubMed
3.
Ostendorf B, Scherer A, Specker C, et al. Jaccoud’s arthropathy in systemic lupus erythematosus: differentiation of deforming and erosive patterns by magnetic resonance imaging. Arthritis Rheum. 2003;48(1):157–65.CrossRefPubMed
4.
Esdaile JM, Danoff D, Rosenthall L, et al. Deforming arthritis in systemic lupus erythematosus. Ann Rheum Dis. 1981;40(2):124–6.CrossRefPubMedPubMedCentral
5.
Gladman DD, Urowitz MB, Rahman P, et al. Accrual of organ damage over time in patients with systemic lupus erythematosus. J Rheumatol. 2003;30(9):1955–9.PubMed
6.
Abu-Shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003;25(1):13–23.CrossRefPubMed
7.
Ramsey-Goldman R, Dunn JE, Huang CF, et al. Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum. 1999;42(5):882–90.CrossRefPubMed
8.
Carli L, Tani C, Spera V, et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med Med. 2016;3:e000098. doi:10.​1136/​lupus-2015-000098.CrossRef
9.
Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, et al. Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus. J Rheumatol. 2001;28(4):761–5.PubMed
10.
Prasad R, Ibanez D, Gladman D, et al. The role of non-corticosteroid related factors in osteonecrosis (ON) in systemic lupus erythematosus: a nested case-control study of inception patients. Lupus. 2007;16:157–62.PubMed
11.
Ehmke TA, Cherian JJ, Wu ES, et al. Treatment of osteonecrosis in systemic lupus erythematosus: a review. Curr Rheumatol Rep. 2014;16:9.CrossRef
12.
Mourao AF, Amaral M, Caetano-Lopes J, et al. An analysis of joint replacement in patients with systemic lupus erythematosus. Lupus. 2009;18(14):1298–302.CrossRefPubMed
13.•
Mukherjee S, Culliford D, Arden N, et al. What is the risk of having a total hip or knee replacement for patients with lupus ? Lupus. 2015;24:198–202. This case-control study utilizing the UK General Practice Research Database found that lupus patients had higher odds of hip and knee replacement and were younger at time of joint replacement than patients with non-inflammatory arthritis.
14.••
Mertelsmann-Voss C, Lyman S, Pan TJ, et al. Arthroplasty rates are increased among US patients with systemic lupus erythematosus : 1991 – 2005. J Rheumatol. 2014;41(5):867–74. Utilizing data from US administrative discharge databases, this study found that between 1991 and 2005 the rates of arthroplasty in SLE doubled and the age at time of surgery increased. The proportion of knee replacements increased and avascular necrosis declined as an indication for surgery.
15.
Trager J, Ward MM. Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol. 2001;13(5):345–51.CrossRefPubMed
16.
Bernatsky S, Boivin JF, Joseph L, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550–7.CrossRefPubMed
17.
Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum. 2013;43(1):77–95.CrossRefPubMed
18.
Aviña-Zubieta JA, Vostretsova K, De Vera MA, et al. The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: a general population-based study. Semin Arthritis Rheum. 2015;45(2):195–201.CrossRefPubMed
19.
Weiss AJ, Elixhauser A, Bae J, et al. Readmissions to US hospitals by diagnosis, 2010. Healthcare Cost and Utilization Project (HCUP) statistical brief #153. Rockville, MD: Agency for Healthcare Research and Quality.:URL: http://​www.​hcup-us.​ahrq.​ gov/reports/statbrie.
20.••
Lin J, Liao C, Lee Y, et al. Adverse outcomes after major surgery in patients with systemic lupus erythematosus : a nationwide population-based study. Ann Rheum Dis. 2014;73:1646–51. This study utilizing the Taiwan National Health Insurance Research Database found that SLE patients had increased rates of adverse outcomes after any major surgery. The risk of adverse events increased in a dose-dependent fashion in patients with recent lupus-related hospitalizations, a surrogate for disease activity.
21.••
Shah UH, Mandl LA, Lee YY, et al. Systemic lupus erythematosus is not a risk factor for poor outcomes after total hip and total knee arthroplasty. Lupus. 2015;24:900–8. This single-center case-control study in the USA found that SLE was not an independent risk factor for poor pain or functional outcomes following TKA and THA. Two-year post-operative WOMAC scores in SLE patients were comparable to those of osteoarthritis patients.
22.
Domsic RT, Lingala B, Krishnan E. Systemic lupus erythematosus, rheumatoid arthritis, and postarthroplasty mortality: a cross-sectional analysis from the nationwide inpatient sample. J Rheumatol. 2010;37(7):1467–72.CrossRefPubMed
23.
Jolly M. How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses? J Rheumatol. 2005;32(9):1706–8.PubMed
24.
Baker K, Pope J. Employment and work disability in systemic lupus erythematosus: a systematic review. Rheumatology. 2009;48(3):281–4.CrossRefPubMed
25.
Harris WH. 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 Jt Surgery. 1969;51(4):737–55.
26.
Kavanagh BF, Fitzgerald RHJ. Clinical and roentgenographic assessment of total hip arthroplasty. A new hip score. Clin Orthop Relat Res. 1985;193:133–40.PubMed
27.
Hanssen AD, Cabenela ME, Michet CJ. Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Jt Surg. 1987;69(6):807–14.
28.
Chen PG, Lin CC. Total hip arthroplasty in patients with systemic lupus erythematosus. J Formos Med Assoc. 1987;86(3):299–306.
29.
Chen YW, Chang JK, Huang KY, et al. Hip arthroplasty for osteonecrosis in patients with systemic lupus erythematosus. Kaohsiung J Med Sci. 1999;15(12):697–703.PubMed
30.
Low CK, Lai CH, Low YP. Results of total hip replacement in systemic lupus erythematosus. Singapore Med J. 1991;32(6):391–2.PubMed
31.
Huo MH, Salvati E, Browne MG, et al. Primary total hip arthroplasty in systemic lupus erythematosus. J Arthroplasty. 1992;7(1):51–6.CrossRefPubMed
32.
Brinker MR, Rosenberg AG, Kull L, et al. Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. J Arthroplasty. 1994;9(5):457–68.CrossRefPubMed
33.
Ito H, Matsuno T, Hirayama T, et al. Health-related quality of life in patients with systemic lupus erythematosus after medium to long-term follow-up of hip arthroplasty. Lupus. 2007;16(5):318–23.CrossRefPubMed
34.
Kang Y, Zhang Z, Zhao X, 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. 2013;23(1):73–9.CrossRefPubMed
35.
Bellamy N, Buchanan W, Goldsmith C, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Orthop Rheumatol. 1988;1:95–108.
36.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMed
37.
Zangger P, Gladman DD, Urowitz MB, et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol. 2000;27(4):919–23.PubMed
38.•
Issa K, Pierce TP, Scillia AJ, et al. Midterm outcomes following total knee arthroplasty in lupus patients. J Arthroplasty. 2015:9-11. doi:10.​1016/​j.​arth.​2015.​09.​049. This single-center case-control study of 34 TKAs in the USA found no difference in post-operative Knee Society or SF-36 scores or complications between lupus patients and non-lupus patients.
39.
Mont MA, Myers TH, Krackow KA, et al. Total knee arthroplasty for corticosteroid associated avascular necrosis of the knee. Clin Orthop Relat Res. 1997;338:124–30.CrossRefPubMed
40.•
Roberts J, Mandl LA, Su E, et al. Systemic lupus erythematosus patients have increased risk of short term adverse events after total hip arthroplasty. Journal of Rheumatology. Published online before print June 15, 2016. doi:10.​3899/​jrheum.​151373. This case-control analysis of 58 THAs at a single center in the USA found that lupus patients had a greater risk of adverse events in the 6 months following THA than osteoarthritis controls.
41.•
González-Contreras M, Merayo-Chalico J, Ortíz-Hernández R, et al. Total hip arthroplasty outcomes: a 17 year experience in a single-center: is systemic lupus erythematosus a real risk factor for adverse outcomes? [abstract]. In: Arthritis & Rheumatology.Vol 67 (suppl).; 2015: http://​acrabstracts.​org/​abstract/​total-hip-arthrop. This single-center case-control study of 58 THAs in Mexico found that lupus was an independent risk factor for immediate complications following THA.
42.
Issa K, Naziri Q, Rasquinha VJ, et al. Outcomes of primary total hip arthroplasty in systemic lupus erythematosus with a proximally-coated cementless stem. J Arthroplasty. 2013;28(9):1663–6.CrossRefPubMed
43.
Woo MS, Kang JS, Moon KH. Outcome of total hip arthroplasty for avascular necrosis of the femoral head in systemic lupus erythematosus. J Arthroplasty. 2013;29(12):2267–70.CrossRefPubMed
44.•
Fein A, Figgie C, Dodds T, et al. 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). http://​acrabstracts.​org/​abstract/​systemic-lupus-erythematosus-does-not-increase-risk-of-adverse-events-in-the-first-6-months-after-total-knee-replacement/​. Accessed July 7, 2016. This single-center case-control study of 52 TKAs in the USA found no increase in complications in lupus patients compared to osteoarthritis controls.