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Dermatomyositis does not adversely affect functional outcomes after total hip arthroplasty: a 1:2 matched
Hongjun Xu1, Zhongyin Ji1, Songlin Li2
1Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, 100730, China.
Background:
Patients with dermatomyositis (DM) are predisposed to osteonecrosis of the femoral head (ONFH), frequently requiring total hip arthroplasty (THA). However, limited evidence exists regarding postoperative outcomes in this population. This study aimed to evaluate functional outcomes and complication rates after THA in patients with DM compared to a matched cohort of patients without DM.
Methods:
A retrospective case-control study was conducted using our institution's arthroplasty registry. We identified 18 patients (21 operations) with DM who underwent primary THA and matched them in a 1:2 ratio to 36 patients (42 operations) who underwent THA for hip osteoarthritis, alcohol-induced ONFH, or Crowe I-II developmental dysplasia of hips (DDH). Functional outcomes and health-related quality of life (QoL) were assessed, and postoperative complications were recorded.
Results:
At a mean follow-up of 4.87 years, both cohorts demonstrated comparable improvements in all functional and QoL measures (all postoperative comparisons, p > 0.05). The rate of complications, including dislocation, periprosthetic joint infection, and revision, was not significantly different between groups. However, respiratory complications occurred more frequently in the DM cohort (4/21 vs. 0/42, p = 0.010). Within the DM group, postoperative respiratory complications showed a preliminary association with higher preoperative D-dimer levels (p = 0.040).
Conclusions:
Patients with DM can achieve excellent functional outcomes after THA, comparable to those of patients without rheumatic autoimmune disease. Although most complication rates are similar, DM patients have an elevated risk of postoperative respiratory complications. Preoperative assessment of D-dimer levels and pulmonary function, along with proactive postoperative respiratory rehabilitation, may help reduce this risk in this vulnerable population.