Total hip arthroplasty in patients with systemic lupus erythematosus
Chen, P.G.; Lin, C.C.
Journal of the Formosan Medical Association 86(3): 299-306
1987
ISSN/ISBN: 0371-7682 PMID: 3598540 Document Number: 294024
Avascular necrosis of the femoral head in patients with systemic lupus erythematosus (SLE) is induced either by long term therapy with prednisolone or partly by vascular changes themselves. The present clinical report includes 14 patients with a total of 23 total hip replacements (THR). All of these patients had severe collapse of the femoral head, manifesting pain and disabled functional status. Thirteen patients were females; only one was male. The age distribution ranged from 18 to 59 years (mean 32.8 years). Nine patients had bilateral hip replacement; the remaining 5 had unilateral replacement. All patients were medicated with prednisolone during the SLE course, and infection was quite common among them. Three had episodes of pneumonia; two had Tb pleurisy and another 2 had septicemia. Cholecystitis, gastro-enteritis and local abscess were noted in 1 patient each. Because of their susceptibility to infection, major surgery needed to be performed with caution. The duration between the establishment of SLE diagnosis to the occurrence of hip symptoms was 6.8 years on the average. In the first 3 patients, Mueller curved cemented prosthesis was used. Later, there was a shift to use of Mittelmeier's cementless ceramic hip prosthesis. The advantages of using this cementless prosthesis were shorter oepration time, good initial result and less friction between the ceramic cup and head interface. These were theoretically beneficial for patients in a muscle-wasting state. The follow-up period was 38 months on the average. Two patients (3 hips) died, but without relation to the operation itself. Amount the remaining 12 patients (20 hips), 14 hips had excellent, 6 had good results.