Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties

Patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) often require total hip arthroplasties. We present a retrospective review of 32 total hip arthroplasties (THA) performed for patients with SLE, RA or AS from 2003 to 2008 in a tertiary hospital in Singapore.

A total of 323 THAs performed between January 2003 to December 2008 were traced and cases of arthroplasties performed for such patients were isolated. Pre- and post-operative range of motion, Harris hip score, limb length discrepancies and complications were studied.

Twenty-six patients aged 24-66 years (mean 47 years) were reviewed, with two AS patients (7.7%), 16 RA patients (61.5%), seven SLE patients (26.9%) and one patient (3.8%) with both RA and SLE. Thirty-two THA operations were conducted with six patients requiring bilateral THAs. The average follow-up was 3.3 years. Mean Harris hip score for 25 patients (one excluded due to patient expiry 2 month post-surgery) improved from 41.3 to 86.53 (P < 0.05). Mean pre-operative hip flexion improved from 61.3 degrees (0-120) to 89.7 degrees (30-120) (P < 0.05). Seventeen cases had preoperative limb length discrepancies (median 1 cm) which were all corrected. There were no implants loosening, infective arthritis, dislocations or neurovascular injuries documented.

Our series demonstrated the excellent outcome of THA for patients with chronic autoimmune arthropathies at the time of follow-up. Careful patient selection remains a priority as long-term outcomes for such patients of a significantly younger population is yet to be determined.