Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
J Arthroplasty. 2017 Nov;32(11):3462-3467. doi: 10.1016/j.arth.2017.06.021. Epub 2017 Jun 19.
In patients with systemic lupus erythematosus (SLE), persistent joint activity and treatment with glucocorticoids are associated with musculoskeletal complications. About 30% of these patients become candidates for surgical treatment. The aim of this study was to evaluate postoperative outcomes after total hip arthroplasty (THA) in SLE patients.
We performed a retrospective cohort study at a tertiary care center in Mexico City between 1995 and 2013. All patients with SLE who underwent THA during that period were included (n = 58). They were compared with 2 control groups, one from another inflammatory arthropathy (rheumatoid arthritis, n = 58) and other noninflammatory (osteoarthritis, n = 58), matched by gender and date of surgery. The primary outcome was the frequency of postoperative complications during follow-up.
We included 174 patients who underwent THA during the study period. Patients with SLE were younger (P < .0001), had a longer hospitalization stay (P = .001), and required more transfusions (P = .004). Global complications in THA in patients with SLE were more prevalent than rheumatoid arthritis (36.2% vs 15.5%, P = .029) and osteoarthritis (36.2% vs 5.1%, P < .0001) patients. After multivariate analysis, risk factors for THA complications were: SLE (hazard ratio 2.8, 95% confidence interval 1.2-6.8; P = .018) and low postoperative hemoglobin (hazard ratio 0.77, 95% confidence interval 0.73-0.83; P < .0001). Long-term complications after THA were similar among groups.
This is the largest single-center study regarding clinical outcomes after THA in SLE patients. Our data suggest that SLE is an independent risk factor for adverse postoperative outcomes, mainly immediate complications, but the long-term outcome is good enough to offer surgical treatment that will improve quality of life.
在系统性红斑狼疮（SLE）患者中，持续性关节活动和糖皮质激素治疗与肌肉骨骼并发症有关。大约 30%的这些患者成为手术治疗的候选者。本研究的目的是评估 SLE 患者全髋关节置换术（THA）后的术后结果。
我们在墨西哥城的一家三级保健中心进行了一项回顾性队列研究，时间为 1995 年至 2013 年。在此期间接受 THA 的所有 SLE 患者均被纳入（n=58）。他们与两个对照组进行了比较，一个来自另一种炎症性关节炎（类风湿关节炎，n=58），另一个来自非炎症性关节炎（骨关节炎，n=58），按性别和手术日期匹配。主要结果是随访期间术后并发症的发生频率。
我们纳入了研究期间接受 THA 的 174 名患者。SLE 患者更年轻（P<.0001），住院时间更长（P=.001），需要更多输血（P=.004）。SLE 患者 THA 的总体并发症比类风湿关节炎（36.2% vs 15.5%，P=.029）和骨关节炎（36.2% vs 5.1%，P<.0001）患者更常见。多变量分析后，THA 并发症的危险因素为：SLE（风险比 2.8，95%置信区间 1.2-6.8；P=.018）和术后低血红蛋白（风险比 0.77，95%置信区间 0.73-0.83；P<.0001）。THA 后长期并发症在各组之间相似。
这是关于 SLE 患者 THA 后临床结果的最大单中心研究。我们的数据表明，SLE 是不良术后结果的独立危险因素，主要是即时并发症，但长期结果足够好，可以提供手术治疗，以提高生活质量。
