Perioperative Management of Total Hip Arthroplasty for Patients with Femoral Head Necrosis with Systemic Lupus Erythematosus_West China Medical Journal

Authors：

 DENGLi-qing ,  KANGPeng-de , PEIFu-xing , SHENBin , YANGJing , ZHOUZong-ke , TANZhen , XIEXiao-wei

Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

KANGPeng-de, Email: kangpd@163.com

Keywords：

Systemic lupus erythematosus; Total hip arthroplasty; Femoral head necrosis; Glucocorticoid; Perioperative period

DOI：

10.7507/1002-0179.20150249

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Objective To study the perioperative treatment of total hip arthroplasty (THA) for avascular necrosis of the femoral head (ANFH) in systemic lupus erythematosus (SLE) patients. Methods The clinical data of 27 patients with SLE and ANFH, who underwent 40 THAs between August 2009 and November 2012 were retrospectively analyzed. There were 5 male and 22 female patients, and the average age of the patients at surgery was 40 years ranging from 21 to 66 years. Fourteen cases had unilateral THA and 13 had bilateral THA. The combined disease included 2 cases of hypertension, 3 chronic bronchitis, 1 autoimmune liver disease and hypohepatia, 2 sicca syndrome, and 2 anemia. Results All the patients were stable peri-operatively. No patient had adrenal crisis. Four complications were noted, including one case of fever reaction (maximum temperature:39.3℃), 1 incision fat liquefaction, 1 pulmonary infection, and 1 early dislocation due to improper exercise on the 12th day after the operation. The patients were followed up for 24 to 53 months, and there was no deep infection, prosthetic loosening, peri-prosthetic fracture or deep vein thrombosis after THA. Conclusion Although the incidence of postoperative complication is high in patients with SLE and ANFH undergoing THA, meticulous perioperative management can help these patients get through operation safely, including the use of glucocorticoid and antibiotics, treatment of osteoporosis, and prevention and treatment of complications.

Citation： DENGLi-qing, KANGPeng-de, PEIFu-xing, SHENBin, YANGJing, ZHOUZong-ke, TANZhen, XIEXiao-wei. Perioperative Management of Total Hip Arthroplasty for Patients with Femoral Head Necrosis with Systemic Lupus Erythematosus. West China Medical Journal, 2015, 30(5): 865-868. doi: 10.7507/1002-0179.20150249 Copy

1.	Kang Y, Zhang ZJ, Zhao XY, 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[J]. Eur J Orthop Surg Traumatol, 2013, 23(1):73-79.
2.	Woo MS, Kang JS, Moon KH. Outcome of total hip arthroplasty for avascular necrosis of the femoral head in systemic lupus erythematosus[J]. J Arthroplasty, 2014, 29(12):2267-2270.
3.	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]. J Arthroplasty, 2013, 28(9):1663-1666.
4.	Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment[J]. J Bone Jiont Surg Br, 1985, 76(1):3-9.
5.	Arlet J, Mazieres B. Natural development of non-traumatic osteonecrosis of the hip[J]. Acta Orthop Belg, 1999, 65(Suppl 1):47-50.
6.	Orban H, Cîrstoiu C, Adam R. Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis[J]. Rom J Intern Med, 2007, 45(1):123-129.
7.	Abu-Shakra M, Urowitz MB, Gladman DD, et al. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death[J]. J Rheumatol, 1995, 22(7):1259-1264.
8.	Ward MM, Pyun E, Studenski S. Causes of death in systemic lupus erythematosus. Long-term followup of an inception cohort[J]. Arthritis Rheum, 1995, 38(10):1492-1499.
9.	Takahashi T, De-La-Garza L, Ponce-De-Leon S, et al. Risk factors for operative morbidity in patients with systemic lupus erythematosus:an analysis of 63 surgical procedures[J]. Am Surg, 1995, 61(3):260-264.
10.	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[J]. Lupus, 2007, 16(5):318-323.
11.	Zangger P, Gladman DD, Urowitz MB, et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus[J]. J Rheumatol, 2000, 27(4):919-923.
12.	Henriques HF, Lebovic D. Defining and focusing perioperative steroid supplementation[J]. Am Surg, 1995, 61(9):809-813.
13.	袁燕林, 吕厚山, 林剑浩, 等. 服用激素的类风湿关节炎患者人工全膝关节置换术[J]. 中华骨科杂志, 2003, 23(10):619-621.
14.	曾春, 宋炎成, 蔡道章, 等. 系统性红斑狼疮合并股骨头坏死行全髋关节置换术的特点及其并发症的防治[J/CD]. 中华关节外科杂志:电子版, 2009, 3(4):454-458.
15.	董健文, 黄冬梅, 戎利民, 等. Ⅰ期双侧全髋关节置换治疗系统性红斑狼疮合并股骨头坏死的早中期疗效[J]. 中华损伤与修复杂志:电子版, 2008, 3(6):705-711.
16.	黄立羡, 练克俭, 郭林新, 等. 系统性红斑狼疮激素治疗后股骨头坏死行人工全髋关节置换术围手术期处理[J]. 临床骨科杂志, 2012, 15(6):607-609.
17.	郭予立, 胡奕山, 林本丹. 合并系统性红斑狼疮的股骨头坏死患者行全髋关节置换术的疗效评估[J]. 广东医学, 2013, 34(19):2984-2986.
18.	Arabmotlagh M, Rittmeister M, Hennigs T. Alendronate prevents femoral periprosthetic bone loss following tota1 hip arthroplasty:prospective randomized double-blind study[J]. J Orthop Res, 2006, 24(7):1336-l341.

1. Kang Y, Zhang ZJ, Zhao XY, 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[J]. Eur J Orthop Surg Traumatol, 2013, 23(1):73-79.
2. Woo MS, Kang JS, Moon KH. Outcome of total hip arthroplasty for avascular necrosis of the femoral head in systemic lupus erythematosus[J]. J Arthroplasty, 2014, 29(12):2267-2270.
3. 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]. J Arthroplasty, 2013, 28(9):1663-1666.
4. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment[J]. J Bone Jiont Surg Br, 1985, 76(1):3-9.
5. Arlet J, Mazieres B. Natural development of non-traumatic osteonecrosis of the hip[J]. Acta Orthop Belg, 1999, 65(Suppl 1):47-50.
6. Orban H, Cîrstoiu C, Adam R. Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis[J]. Rom J Intern Med, 2007, 45(1):123-129.
7. Abu-Shakra M, Urowitz MB, Gladman DD, et al. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death[J]. J Rheumatol, 1995, 22(7):1259-1264.
8. Ward MM, Pyun E, Studenski S. Causes of death in systemic lupus erythematosus. Long-term followup of an inception cohort[J]. Arthritis Rheum, 1995, 38(10):1492-1499.
9. Takahashi T, De-La-Garza L, Ponce-De-Leon S, et al. Risk factors for operative morbidity in patients with systemic lupus erythematosus:an analysis of 63 surgical procedures[J]. Am Surg, 1995, 61(3):260-264.
10. 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[J]. Lupus, 2007, 16(5):318-323.
11. Zangger P, Gladman DD, Urowitz MB, et al. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus[J]. J Rheumatol, 2000, 27(4):919-923.
12. Henriques HF, Lebovic D. Defining and focusing perioperative steroid supplementation[J]. Am Surg, 1995, 61(9):809-813.
13. 袁燕林, 吕厚山, 林剑浩, 等. 服用激素的类风湿关节炎患者人工全膝关节置换术[J]. 中华骨科杂志, 2003, 23(10):619-621.
14. 曾春, 宋炎成, 蔡道章, 等. 系统性红斑狼疮合并股骨头坏死行全髋关节置换术的特点及其并发症的防治[J/CD]. 中华关节外科杂志:电子版, 2009, 3(4):454-458.
15. 董健文, 黄冬梅, 戎利民, 等. Ⅰ期双侧全髋关节置换治疗系统性红斑狼疮合并股骨头坏死的早中期疗效[J]. 中华损伤与修复杂志:电子版, 2008, 3(6):705-711.
16. 黄立羡, 练克俭, 郭林新, 等. 系统性红斑狼疮激素治疗后股骨头坏死行人工全髋关节置换术围手术期处理[J]. 临床骨科杂志, 2012, 15(6):607-609.
17. 郭予立, 胡奕山, 林本丹. 合并系统性红斑狼疮的股骨头坏死患者行全髋关节置换术的疗效评估[J]. 广东医学, 2013, 34(19):2984-2986.
18. Arabmotlagh M, Rittmeister M, Hennigs T. Alendronate prevents femoral periprosthetic bone loss following tota1 hip arthroplasty:prospective randomized double-blind study[J]. J Orthop Res, 2006, 24(7):1336-l341.

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Perioperative Management of Total Hip Arthroplasty for Patients with Femoral Head Necrosis with Systemic Lupus Erythematosus

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