Femoral Head Osteonecrosis in Systemic Lupus Erythematosus: Total Hip Arthroplasty Outcomes and Considerations

Osteonecrosis of the femoral head disproportionately affects patients with systemic lupus erythematosus (SLE) and is the most frequent indication for total hip arthroplasty (THA) in these patients.

Patients with SLE are more likely to undergo THA than those without the disease, and they elect for the procedure at a younger age. More arthroplasty procedures are currently being performed on patients with SLE as the all-cause rate of arthroplasty is increasing similarly to that of the general population.

Postoperatively, patients with SLE report similar functional outcomes but lower physical quality of life compared with their peers. Sociodemographic factors should be considered as barriers to recovery and should be taken into account during patient counseling.

Past research regarding the postoperative infection risk following THA in patients with SLE has been unclear. Recent high-power data indicate that these patients have a higher risk of periprosthetic infection for unclear reasons.

SLE is an independent risk factor for perioperative medical complications, including the need for blood transfusion, genitourinary complications, sepsis, acute renal disease, deep venous thrombosis, and falls, among other adverse events. The current perioperative treatment guidelines were founded on low-to-moderate-quality studies.