Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2020 Mar 3

PMID 32117536

Citations 10

Authors

Keith T Aziz

Matthew J Best

Richard L Skolasky

Karthik E Ponnusamy

Robert S Sterling

Harpal S Khanuja

Affiliations

Soon will be listed here.

Abstract

Background: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.

Methods: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.

Results: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).

Conclusions: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.

Citing Articles

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Elastic Compression Dressing after Total Hip Replacement Slightly Reduces Leg Swelling: A Randomized Controlled Trial.

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Screening for Asymptomatic Osteonecrosis of the Hip in Systemic Lupus Erythematous: A Systematic Review and Meta-Analysis of MRI-Based Prevalence.

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Understanding factors that impact the length of stay after total hip arthroplasty - A national in-patient sample-based study.

Venishetty N, Beale J, Martinez J, Mounasamy V, Sambandam S J Clin Orthop Trauma. 2023; 46:102284.

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The impact of Behcet syndrome on total knee arthroplasty outcomes: a retrospective matched cohort study.

Zhang Z, Driskill E, Chi J, Duensing I, Cui Q Int Orthop. 2023; 47(8):1989-1994.

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References

Apostolopoulos D, Morand E . It hasn't gone away: the problem of glucocorticoid use in lupus remains. Rheumatology (Oxford). 2016; 56(suppl_1):i114-i122. DOI: 10.1093/rheumatology/kew406. View

Bernatsky S, Boivin J, Joseph L, Manzi S, Ginzler E, Gladman D . Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006; 54(8):2550-7. DOI: 10.1002/art.21955. View

Roberts J, Mandl L, Su E, Mayman D, Figgie M, Fein A . Patients with Systemic Lupus Erythematosus Have Increased Risk of Short-term Adverse Events after Total Hip Arthroplasty. J Rheumatol. 2016; 43(8):1498-502. DOI: 10.3899/jrheum.151373. View

Meacock R, Dale N, Harrison M . The humanistic and economic burden of systemic lupus erythematosus : a systematic review. Pharmacoeconomics. 2013; 31(1):49-61. DOI: 10.1007/s40273-012-0007-4. View

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43(11):1130-9. DOI: 10.1097/01.mlr.0000182534.19832.83. View

Al Kazzi E, Lau B, Li T, Schneider E, Makary M, Hutfless S . Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System. PLoS One. 2015; 10(11):e0140165. PMC: 4633065. DOI: 10.1371/journal.pone.0140165. View

Mertelsmann-Voss C, Lyman S, Pan T, Goodman S, Figgie M, Mandl L . US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheumatol. 2014; 66(6):1432-9. PMC: 10202131. DOI: 10.1002/art.38384. View

Trager J, Ward M . Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol. 2001; 13(5):345-51. DOI: 10.1097/00002281-200109000-00002. View

Bozic K, Bashyal R, Anthony S, Chiu V, Shulman B, Rubash H . Is administratively coded comorbidity and complication data in total joint arthroplasty valid?. Clin Orthop Relat Res. 2012; 471(1):201-5. PMC: 3528892. DOI: 10.1007/s11999-012-2352-1. View

10.

Kamen D . Environmental influences on systemic lupus erythematosus expression. Rheum Dis Clin North Am. 2014; 40(3):401-12, vii. PMC: 4198387. DOI: 10.1016/j.rdc.2014.05.003. View

11.

Ponnusamy K, Kim T, Khanuja H . Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am. 2014; 96(21):1836-44. DOI: 10.2106/JBJS.N.00128. View

12.

Abu-Shakra M, Buskila D, Shoenfeld Y . Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003; 25(1):13-24. DOI: 10.1385/CRIAI:25:1:13. View

13.

Stratta P, Mesiano P, Campo A, Grill A, Ferrero S, Santi S . Life expectancy of women with lupus nephritis now approaches that of the general population. Int J Immunopathol Pharmacol. 2010; 22(4):1135-41. DOI: 10.1177/039463200902200432. View

14.

Esdaile J, Danoff D, Rosenthall L, Gutkowski A . Deforming arthritis in systemic lupus erythematosus. Ann Rheum Dis. 1981; 40(2):124-6. PMC: 1000692. DOI: 10.1136/ard.40.2.124. View

15.

Mertelsmann-Voss C, Lyman S, Pan T, Goodman S, Figgie M, Mandl L . Arthroplasty rates are increased among US patients with systemic lupus erythematosus: 1991-2005. J Rheumatol. 2014; 41(5):867-74. DOI: 10.3899/jrheum.130617. View

16.

Stratta P, Marcuccio C, Campo A, Sandri L, Messuerott A, Colla L . Improvement in relative survival of patients with vasculitis: study of 101 cases compared to the general population. Int J Immunopathol Pharmacol. 2008; 21(3):631-42. DOI: 10.1177/039463200802100317. View

17.

Di Franco M, Bazzichi L, Casale R, Sarzi-Puttini P, Atzeni F . Pain in systemic connective tissue diseases. Best Pract Res Clin Rheumatol. 2015; 29(1):53-62. DOI: 10.1016/j.berh.2015.05.006. View

18.

Chen Y, Chen Z, Cui S, Li Z, Yuan Z . Topical versus systemic tranexamic acid after total knee and hip arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016; 95(41):e4656. PMC: 5072927. DOI: 10.1097/MD.0000000000004656. View

19.

Borchers A, Naguwa S, Shoenfeld Y, Gershwin M . The geoepidemiology of systemic lupus erythematosus. Autoimmun Rev. 2009; 9(5):A277-87. DOI: 10.1016/j.autrev.2009.12.008. View

20.

Issa K, Pierce T, Scillia A, Festa A, Harwin S, Mont M . Midterm Outcomes Following Total Knee Arthroplasty in Lupus Patients. J Arthroplasty. 2015; 31(3):655-7. DOI: 10.1016/j.arth.2015.09.049. View