J Korean Rheum Assoc.  2008 Sep;15(3):237-243. 10.4078/jkra.2008.15.3.237.

Primary Total Hip Arthroplasty in Systemic Lupus Erythromatosus

• Moon KH
• Lee TJ
• Choi SW
• Jung SR

• KMID: 1270202
• DOI: http://doi.org/10.4078/jkra.2008.15.3.237

Abstract

OBJECTIVE: The purpose of this study is to evaluate the short term results of total hip arthroplasty (THA) for avascular necrosis in patients with systemic lupus erythematosus (SLE). METHODS: This is a retrospective case control, matched pair study. Ten patients (15 hips) with SLE and avascular necrosis of the femoral head (AVNFH) underwent THA. Eight patients (12hips) with a minimum follow up of 2 years were reviewed. To determine whether these patients had results similar to those of patients with other diagnosis, we formed a control group of 12 patients who had 12 THA. They were matched for age, sex, BMI, activity, follow-up period, and type of implant with SLE group. The clinical and radiographic results were evaluated by Harris hip score (HSS) and serial radiographic findings, respectively. RESULTS: There was no complication during the perioperative period. In the SLE group, HHS was from 67.3 preoperatively to 97.7 at last follow-up. In the control group, HHS was from 70.1 preoperatively to 97.8 at last follow-up. On the last roentgenograms, none of acetabular components demonstrated any evidence of migration, tilt, rotation or shedding of metal particles in both groups. All femoral components demonstrated no evidence of subsidence, pedestal, or shedding of metal particles in both groups. CONCLUSION: Patients with SLE and AVNFH had excellent results after THA. Results were not different from that of patients who had hip replacement for other diagnoses. Therefore, it is considered that uncemented THA was useful treatment method for the patient who had SLE and AVNFH.

Keyword

Total hip replacement arthroplasty; Systemic lupus erythromatosus

Figure

• 

  Fig. 1. These images show a 36 year-old woman with SLE. (A) Initial radiograph reveals that collapsed both femoral head and acetabular sclerotic change. (B) Both hip MRI reveals double line sign of both femoral head. (C) Two years after primary total hip arthropasty, the femoral and acetabular components of both hip were stable.

Reference

References

1. Dubois EL, Cozen L. Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA. 1960; 174:966–71.

2. Kalla AA, Learmonth ID, Klemp P. Early treatment of avascular necrosis in systemic lupus erythematosus. Ann Rheum Dis. 1986; 45:649–52.

3. Bergstein JM, Wiens C, Fish AJ, Vernier RL, Michael A. Avascular necrosis of bone in systemic lupus erythematosus. J Pediatr. 1974; 85:31–5.

4. Zizic TM. Systemic lupus erythematosus X: corticosteroid therapy and its complications. Md State Med J. 1984; 33:370–81.

5. Gladman DD, Urowitz MB. Morbidity in systemic lupus erythematosus. J Rheumatol Suppl. 1987; 14(Suppl 13):223–6S.

6. Zizic TM, Hungerford DS, Stevens MB. Ischemic bone necrosis in systemic lupus erythematosus. II. The early diagnosis of ischemic necrosis of bone. Medicine (Baltimore). 1980; 59:134–42.

7. Ficat RP, Arlet J. Ischemia and necroesis of bone. 171–82. Baltimore, etc, Williams and Wilkins,. 1980.

8. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone and Joint Surg. 1969; 51-A:737–55.

9. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976; 121:20–32.

10. Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res. 1990; 261:63–81.

11. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990; 257:107–28.

12. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; 141:17–27.

13. Martell JM, Berdia S. Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am. 1997; 79:1635–41.

14. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987; 69:45–55.

15. Von Knoch M, Sychterz CJ, Engh CA Jr, Engh CA Sr. Incidence of late bead shedding from uncemented porous coated cups. A radiographic evaluation. Clin Orthop Relat Res. 1997; 342:99–105.

16. Cole TJ, freeman JV, Preece MA. Weight-stature indices to measure underweight, overweight, and obesity. In: Himes JH, ed., Anthropometric assessment of nutritional status. p.83–112. New York, Wiley and Son,. 1991.

17. Hungerford DS, Zizic TM. II. The treatment of ischemic necrosis of bone in systemic lupus erythematosus. Medicine (Baltimore). 1980; 59:143–8.

18. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br. 1995; 77:42–9.

19. Ko JY, Meyers MH, Wenger DR. “Trapdoor” procedure for osteonecrosis with segmental collapse of the femoral head in teenagers. J Pediatr Orthop. 1995; 15:7–15.

20. Steinberg ME. Core decompression of the femoral head for avascular necrosis: indications and results. Can J Surg. 1995; 38(Suppl 1):18–24S.

21. Rosenwasser MP, Garino JP, Kiernan HA, Michelsen CB. Long term followup of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop Relat Res. 1994; 306:17–27.

22. Yoo MC, Chung DW, Hahn CS. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res. 1992; 277:128–38.

23. Zangger P, Gladman DD, Urowitz MB, Bogoch ER. Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol. 2000; 27:919–23.

24. Kunec JR. Total hip replacement in patients under thirty-five years of age. Orthopadics. 1983; 6:1432–34.

25. Prupas HM, Patzakis M, Quismorio FP Jr. Total hip arthroplasty for avascular necrosis of the femur in systemic lupus erythematosus. Clin Orthop Relat Res. 1981; 161:186–90.

26. Chen PG, Lin CC. Total hip arthroplasty in patients with systemic lupus erythematosus. Taiwan Yi Xue Hui Za Zhi. 1987; 86:299–306.

27. Hanssen AD, Cabanela ME, Michet CJ Jr. Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Joint Surg Am. 1987; 69:807–14.

28. Huo MH, Salvati EA, Browne MG, Pellicci PM, Sculco TP, Johanson NA, et al. Primary total hip arthroplasty in systemic lupus erythematosus. J Arthroplasty. 1992; 7:51–6.

29. Mogensen B, Brattstrom H, Ekelund L, Lidgren L. Total hip replacement in juvenile chronic arthritis. Acta Orthop Scand. 1983; 54:422–30.

30. Williams WW, McCullough CJ. Results of cemented total hip replacement in juvenile chronic arthritis. A radiological review. J Bone Joint Surg Br. 1993; 75:872–4.

31. Lehtimaki MY, Lehto MU, Kautiainen H, Savolainen HA, Hamalainen MM. Survivorship of the Charnley total hip arthroplasty in juvenile chronic arthritis. A follow-up of 186 cases for 22 years. J Bone Joint Surg Br. 1997; 79:792–5.

32. Joshi AB, Porter ML, Trail IA, Hunt LP, Murphy JC, Hardinge K, et al. Long-term results of Charnley low-friction arthroplasty in young patients. J Bone Joint Surg Br. 1993; 75:616–23.

33. Park YS, Hwang SK, Choy WS, Kim YS, Moon YW, Lim SJ, et al. Ceramic failure after total hip arthroplasty with an alumina-on-alumina bearing. J Bone Joint Surg Am. 2006; 88:780–87.