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Impact of Systemic Lupus Erythematosus on Short-Term and Long-Term Outcomes in Total Knee Arthroplasty: A National
Abdul-Lateef Shafau1, Ameen Suhrawardy, Hussein Alazawi
1From the Department of Orthopaedics, Detroit Medical Center (Dr. Shafau, Dr. Suhrawardy, Dr. Hasan, Dr. Saleh, and Dr. Darwiche), Detroit, MI; Department of Orthopaedic Surgery (Alazawi, Almaat), the Corewell Health Hospital, Farmington Hills, MI; the Department of Orthopedic Surgery (Kazi), Wayne State University School of Medicine, Detroit, MI; the College of Medicine (Yazdani), Central Michigan University, Mount Pleasant, MI; School of Medicine (Diab), the University of Texas Medical Branch, Galveston, TX; and the School of Medicine (Diab), University of Michigan, Ann Arbor, MI.
Background:
Systemic lupus erythematosus (SLE) is a chronic autoimmune condition that elevates perioperative risk in patients undergoing total knee arthroplasty (TKA), including thromboembolic, renal, and infectious complications. Previous studies have been limited by small sample sizes and inadequate cohort matching. This study aims to evaluate 90-day and 2-year complications in SLE patients undergoing TKA using a large, propensity-matched national database.
Methods:
A retrospective cohort analysis was conducted using the TriNetX database. A total of 920 SLE patients undergoing primary TKA were 1:1 matched to non-SLE controls based on demographics and comorbidities. Patients with drug-induced lupus were excluded. Outcomes included medical complications (e.g., DVT, pulmonary embolism, myocardial infarction, renal failure, infection, sepsis, ED visits, readmissions) and mechanical complications (e.g., aseptic loosening, implant failure, revision, dislocation, deep surgical site infection). Kaplan-Meier survival analysis and risk ratio comparisons were done (significance set at P < 0.05).
Results:
At 90 days, SLE patients had markedly higher rates of DVT (3.5% vs 2.1%; P = 0.020) and ED visits (11.4% vs 8.2%; P = 0.006). At 2 years, they experienced increased pulmonary embolism (3.9% vs 2.4%; P = 0.021), DVT (8.2% vs 5.1%; P = 0.001), myocardial infarction (3.0% vs 1.8%; P = 0.046), renal failure (9.7% vs 5.2%; P < 0.001), readmissions (6.0% vs 3.6%; P = 0.004), ED visits (30.4% vs 26.9%; P = 0.041), deep SSI (4.9% vs 3.4%; P = 0.044), and dislocation (1.9% vs 1.0%; P = 0.036).
Conclusion:
SLE patients undergoing TKA demonstrate increased risk for thromboembolic events, renal failure, ED utilization, deep infection, and dislocation.