Fein Arielle W, Figgie Caroline A, Dodds Taylor R, Wright-Chisem Joshua, Parks Michael L, Mandl Lisa A, Su Edwin P, Salmon Jane E, Mayman David J, Lee Yuo-Yu, Figgie Mark P, Goodman Susan M
From the *Hospital for Special Surgery, New York, NY; †Columbia University College of Physicians and Surgeons, New York, NY; ‡Case Western Reserve University School of Medicine, Cleveland, OH; §St. George's University School of Medicine, New York, NY; ∥University of Illinois at Chicago College of Medicine, Chicago, IL; ¶Weill Cornell Medical College, New York, NY; and #Weill Cornell Graduate School of Medical Sciences, New York, NY.
J Clin Rheumatol. 2016 Oct;22(7):355-9. doi: 10.1097/RHU.0000000000000435.
Increasing numbers of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA). Whether postsurgical adverse events (AEs) are higher in patients with SLE than patients with osteoarthritis (OA) is unknown.
This study aims to compare AEs within 6 months of TKA.
Patients in a single institution's arthroplasty and SLE registries who underwent TKA from 2007 to 2014 were eligible. SLE cases were matched 1:2 to OA on age, sex, year of TKA, and procedure type. AEs were collected through chart review and registry responses. Baseline characteristics were compared and regression analysis performed to determine predictors of AEs.
Fifty-two SLE TKA were matched to 104 OA TKA. There was no difference in follow-up between groups. SLE patients had more comorbidities (≥1 Charlson-Deyo comorbidity: SLE 38.4% vs. OA 17.3%; P-value < 0.001) and steroid use (preoperative [SLE 28.8% vs. OA 1.9%, P-value < 0.001] and perioperative "stress-dose" [30.8% vs. 2.9%, P-value = 0.01]). SLE patients did not experience more major (SLE 25.0% vs. OA 19.2%; P-value = 0.41), minor (15.4% vs. 10.6%; P-value = 0.39), or total (38.5% vs. 27.9%; P-value = 0.18) AEs. AEs were not increased among patients on stress-dose steroids. In a multiple logistic regression analysis controlling for comorbidities and diagnosis, neither SLE (OR 1.61, 95% CI 0.74-3.50) nor >1 comorbidity (OR 1.05, 95% CI 0.46-2.39) was an independent risk factor for AEs.
SLE is not an independent risk factor for increased AEs 6 months after TKA. Stress-dose steroid use does not heighten AE risk. These findings should inform recommendations for SLE patients considering TKA.
越来越多的系统性红斑狼疮（SLE）患者正在接受全膝关节置换术（TKA）。SLE患者术后不良事件（AE）是否高于骨关节炎（OA）患者尚不清楚。
本研究旨在比较TKA术后6个月内的不良事件。
符合条件的患者来自单一机构的关节置换术和SLE登记处，他们在2007年至2014年期间接受了TKA。SLE病例在年龄、性别、TKA年份和手术类型方面与OA病例按1:2进行匹配。通过病历审查和登记回复收集不良事件。比较基线特征并进行回归分析以确定不良事件的预测因素。
52例SLE患者的TKA与104例OA患者的TKA相匹配。两组之间的随访情况没有差异。SLE患者有更多的合并症（≥1项Charlson-Deyo合并症：SLE为38.4%，OA为17.3%；P值<0.001）和使用类固醇的情况（术前[SLE为28.8%，OA为1.9%，P值<0.001]和围手术期“应激剂量”[30.8%对2.9%，P值=0.01]）。SLE患者并未经历更多的严重不良事件（SLE为25.0%，OA为19.2%；P值=0.41）、轻微不良事件（15.4%对10.6%；P值=0.39）或总体不良事件（38.5%对27.9%；P值=0.18）。接受应激剂量类固醇治疗的患者不良事件并未增加。在控制合并症和诊断的多因素逻辑回归分析中，SLE（比值比1.61，95%置信区间0.74-3.50）和>1种合并症（比值比1.05，95%置信区间0.46-2.39）均不是不良事件的独立危险因素。
SLE不是TKA术后6个月不良事件增加的独立危险因素。应激剂量类固醇的使用不会增加不良事件风险。这些发现应为考虑进行TKA的SLE患者的建议提供参考。
