Intraoperative complications in patients with systemic lupus erythematosus during total hip replacement

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic disease of unknown etiology characterized by systemic immuno-inflammatory damage to vital organs. A serious complication of SLE is aseptic bone necrosis, which is characterized by severe pain syndrome, impaired joint function, decreased quality of life and disability. Despite the fact that hip replacement is a technically proven method of surgical treatment, patients with SLE are still at increased risk of complications at all stages of the perioperative period.

AIM: the aim of the work is to describe the effect of SLE on the development of intraoperative complications during hip replacement.

MATERIALS AND METHODS: The study included 133 patients diagnosed with SLE who underwent total hip replacement between 1998 and 2021. All surgical interventions were performed in the traumatology and orthopaedic department. The group of patients with SLE was dominated by women, the ratio of women to men was 7.3:1, respectively. The average age of patients at the time of surgery was 36.6±12.6 years.

RESULTS: Hip replacement in all patients (n=133) was performed as standard in the patient’s position on the healthy side from the anterolateral Harding access. In 75 cases (56.3%), additional fixation of the acetabulum component with screws was performed. In 10 cases, a cerclage was applied to the proximal femur due to a fracture that occurred during the development of the bone marrow canal. To clarify the factors influencing the development of an intraoperative fracture, patients with SLE were divided into 2 groups: the first group (n=10) — with an intraoperative fracture, the second (n=123) — without a fracture. The comparative characteristics of the first and second groups are carried out. Another complication at the stage of surgical treatment is an increased volume of blood loss, which required transfusion of erythrocyte suspension. There were 54 such patients (40.6%). In relation to patients with increased blood loss, we compared the clinical and laboratory characteristics of patients immediately before surgical treatment, with and without increased blood loss.

CONCLUSION: In the study, we analyzed the resulting intraoperative complications. We have not received confirmation of the effect of daily and cumulative doses of HA, as well as the degree of activity and course of SLE on the risk of intraoperative fracture. The probability of fracture was significantly higher in patients with initially reduced bone mineral density. With regard to the increased volume of blood loss in patients with SLE, a significant association was found with baseline anemia (reduced hemoglobin and hematocrit levels) in the preoperative period (p<0.001).

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