Primary Total Hip Arthroplasty in Systemic Lupus Erythromatosus

Kyoung Ho Moon; Tong Joo Lee; Sung Wook Choi; Sae Rom Jung

doi:10.4078/jkra.2008.15.3.237

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Moon, Lee, Choi, and Jung: Primary Total Hip Arthroplasty in Systemic Lupus Erythromatosus

Original Article

J Korean Rheum Assoc 2008;15(3):237-143.

Published online: 20 September 2008

DOI: https://doi.org/10.4078/jkra.2008.15.3.237

Primary Total Hip Arthroplasty in Systemic Lupus Erythromatosus

Kyoung Ho Moon, Tong Joo Lee, Sung Wook Choi, Sae Rom Jung

Department of Orthopaedic Surgery, College of Medicine, Inha University, Incheon, Korea

Received 1 July 2008 Accepted 25 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The purpose of this study is to evaluate the short term results of total hip arthroplasty (THA) for avascular necrosis in patients with systemic lupus erythematosus (SLE).

Methods

This is a retrospective case control, matched pair study. Ten patients (15 hips) with SLE and avascular necrosis of the femoral head (AVNFH) underwent THA. Eight patients (12hips) with a minimum follow up of 2 years were reviewed. To determine whether these patients had results similar to those of patients with other diagnosis, we formed a control group of 12 patients who had 12 THA. They were matched for age, sex, BMI, activity, follow-up period, and type of implant with SLE group. The clinical and radiographic results were evaluated by Harris hip score (HSS) and serial radiographic findings, respectively.

Results

There was no complication during the perioperative period. In the SLE group, HHS was from 67.3 preoperatively to 97.7 at last follow-up. In the control group, HHS was from 70.1 preoperatively to 97.8 at last follow-up. On the last roentgenograms, none of acetabular components demonstrated any evidence of migration, tilt, rotation or shedding of metal particles in both groups. All femoral components demonstrated no evidence of subsidence, pedestal, or shedding of metal particles in both groups.

Conclusion

Patients with SLE and AVNFH had excellent results after THA. Results were not different from that of patients who had hip replacement for other diagnoses. Therefore, it is considered that uncemented THA was useful treatment method for the patient who had SLE and AVNFH.

Keywords: Total hip replacement arthroplasty, Systemic lupus erythromatosus

References

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Fig. 1.

These images show a 36 year-old woman with SLE. (A) Initial radiograph reveals that collapsed both femoral head and acetabular sclerotic change. (B) Both hip MRI reveals double line sign of both femoral head. (C) Two years after primary total hip arthropasty, the femoral and acetabular components of both hip were stable.

Table 1.

Demographic data of SLE∗ group

case	sex	Age (year)	BMI (kg/m²)	activity	F/U^† Period (month)	Preoperative HHS^‡	Dose of steriod	F‐A^§stage
1	F	29	23.1	moderate	66	72	4 mg/d	3
2(Rt)	F	56	23.5	moderate	37	69	5 mg/d	4
2(Lt)	F	56	23.5	moderate	37	69	5 mg/d	4
3	F	57	24.2	moderate	24	70	4 mg/d	4
4(Rt)	F	36	20.7	moderate	24	65	4 mg/d	4
4(Lt)	F	36	20.7	moderate	24	65	4 mg/d	4
5(Rt)	F	30	21.6	moderate	30	68	4 mg/d	4
5(Lt)	F	30	21.6	moderate	24	68	4 mg/d	4
6	F	45	23.6	moderate	30	52	4 mg/d	4
7(Rt)	F	43	20.8	moderate	60	71	4 mg/d	3
7(Lt)	F	42	20.8	moderate	72	71	4 mg/d	4
8	F	31	23.5	moderate	30	68	5 mg/d	3

^∗ SLE: Systemic lupus erythromatosus,

^† F/U: follow up,

^‡ HHS: Harris hip score,

^§ F-A: Ficat and arlet

Table 2.

Comparison of two groups

SLE^∗ (n=12) non-SLE (n=12) p-value^†
Age (years) 40.9 43.5 0.340
Sex all females all females 1
Activity all moderate all moderate 1
activity activity
Body mass 22.3 21.9 0.311
index (kg/m²)
Follow-up 38.9 37.8 0.977
period (months)
Implant type all non-all non-1
cemented type cemented type

^∗ SLE: Systemic lupus erythromatosus,

^† The p-value was calculated by Mann-Whiney U-test (SPSS version 12.0)

Table 3.

The clinical and radiological results

	SLE^∗ (n=12)	Non SLE (n=12)	p-value^†
HHS^‡ increment	30.4	27.7	0.930
Stability	10	11
bone ingrowth
fibrous ingrowth	2	1	0.544
unstable	0	0
Stress shield	7	8	0.651
Wear
linear (mm/yr)	0.231 (n=2)	0.250 (n=4)	0.787
volumetric (mm³/yr)	135.42 (n=2)	136.70 (n=4)	0.633
Complication	0	0	1

^∗ SLE: Systemic lupus erythromatosus,

^† The p-value was calculated by Mann-Whiney U-test and Chi square test (SPSS version 12.0),

^‡ HHS: Harris hip score

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