Perioperative Management And Clinical Outcomes Of Total Hip Arthroplasty For Avascular Necrosis In Systemic Lupus Erythematosus

Objective Avascular necrosis of the femoral head is one of the most frequentlycomplications in patients with systemic lupus erythematosus (SLE) and oftenrequires total hip arthroplasty (THA). The purpose of this study was to analyzethe short term clinical outcomes associated with THA in patients with SLE.Methods Between2009and2012,24THAs performed for16patients withSLE. Three patients were lost to follow-up. The remaining21hips in13patients including12women and1men, with an average age at surgery of34（22-57） years and an average follow-up of30(15-60) months were assessed.All patients had Ficat III or IV necrosis of the femoral head. HHS, WOMAC,SF-36scores and radiographic results were evaluated in all cases pre-andpost-operatively for functional recovery of the hip and health-related quality oflife (HRQOL).Results The mean surgical time of21hips was106mins(range,44-175mins).The average blood loss during surgery was476ml (range,200–1000ml).All the patients required a blood transfusion with a mean volume of3.5units(range,2–8units [1unit=200ml]). All the patients were stable perioperatively.No patient occurred adrenal crisis,1with eczema and sore of lumbosacralregion,1with acute respiratory infections,2with fever,1case with earlyprosthesis dislocation, which were improved and recovered after propertreatments. There were no infection around prosthesis and no radiologicalevidence of implant loosening. None of the patients required a revision. Astatistically significant improvement in all scores was found comparing pre-and post-operative conditions (P<0.05). Conclusion THA is an acceptable method for achieving functional recoveryand increasing HRQOL in patients with SLE and ANFH. THA has good resultsin the short term follow-up. Our series demonstrated the excellent outcome forpatients with proper perioperative management.