Patients with Lupus More Prone to Post-operative Complications

An abstract presented during the American Academy of Orthopaedic Surgeons Annual Meeting 2015 in Las Vegas, revealed that patients with systemic lupus erythematosus (SLE) who had undergone total hip arthroplasty (THA) were nearly five times more likely to experience post-operative complications when compared to patients with osteoarthritis.

Dr. Mark P. Figgie from the Hospital for Special Surgery, said during his presentation, “Lupus patients have higher rates of complications following hip replacement as compared to [osteoarthritis] OA patients, even when controlling for other comorbidities. Adverse events were not correlated with immunosuppressant medication use. Despite improvements in disease management, patients with lupus should still be recognized as high risk patients in total hip replacement.”

Further, Dr. Figgie explained that these SLE patients’ use of immunosuppressants may be playing a major role in the development of such adverse events, however his study did not reference to any drug in particular.

To arrive at these conclusions, Dr. Figgue and his team of researchers enrolled 58 SLE patients who were matched by age and gender to 116 patients with OA. All participants had previously undergone THA at one center. Those with SLE met at least 3 of 11 of the American College of Rheumatology’s criteria, and underwent a confirmation of their diagnosis by a rheumatologist.

The investigators found that almost 80% of SLE patients were on immunosuppressants, compared to a mere 2% of OA patients. Baseline assessments showed SLE patients registered higher WOMAC pain scores than those with OA. While all participants’ perioperative surgical times were similar, Dr. Figgie noted that those with SLE received more aggressive postoperative deep vein thrombosis prophylaxis and spinal anesthesia.

“The patients with lupus had more minor adverse events being driven specifically by superficial surgical site infection. They also had more major adverse events,” he said.

Researchers also noted that SLE patients spent more time in the hospital post-operatively, spending an average of 6 days when compared to OA patients’ 4.7 days. According to the abstract, SLE patients also had higher rates of falls, revision surgeries, DVT, and acute renal disease within 6 months of their THA.

“Interestingly, we tried to correlate the use of different immunosuppressant medications with the complications of lupus and we were unable to do that,” said Dr. Figgie.

This study is the largest to explore post-THA complications among patients with SLE. “But, it was limited and underpowered for differences in rare events like death, and it is also a single, high-volume institution, which may or may not be generalizable to the general use of hip replacement,” Dr. Figgie added.