Patients with Systemic Lupus Erythematosus Have Increased Risk of Short-term Adverse Events after Total Hip Arthroplasty.
Total hip arthroplasty (THA) is performed more frequently in patients with systemic lupus erythematosus (SLE) than in the general population. However, whether patients with SLE have higher complication rates than patients with osteoarthritis (OA) is unknown. This study compares adverse events (AE) in SLE with OA controls.



Patients in our institution's registry were eligible. SLE was identified by the International Classification of Diseases, 9th ed code. AE were identified by chart review and questionnaire. Patients with SLE were matched with OA controls. Multivariate regression was performed to identify independent predictors of AE.



Fifty-eight patients with SLE THA were matched with 116 OA controls. Of the patients with SLE, 47.4% had Charlson-Deyo comorbidity scores (excluding SLE) > 1 versus 13.1% of OA (p < 0.0001). Length of stay was longer for SLE (6.0 days vs 4.7 days, p = 0.0008). Patients with SLE had more falls (10.3% vs 1.7%, p = 0.017), deep vein thrombosis (5.2% vs 0%, p = 0.036), acute renal disease (8.6% vs 0%, p = 0.004), wound infections (6.9% vs 0.9%, p = 0.043), and revision surgeries (5.2% vs 0%, p = 0.036). In a logistic regression controlling for comorbidities, SLE had an increased risk of AE (OR 3.77, 95% CI 1.74-8.16). Comorbidity scores were not significantly associated with AE. Among those with SLE, there were no significant differences in AE in those taking corticosteroids.



SLE is an independent risk factor for AE after THA. Patients with SLE had higher rates of falls, acute renal disease, infections, and revision surgeries than matched OA controls. Further research is needed to understand the causes of increased AE in patients with SLE.
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College. jor2035@med.cornell.edu.
Jordan E
JE
Roberts
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Lisa A
LA
Mandl
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Edwin P
EP
Su
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
David J
DJ
Mayman
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Mark P
MP
Figgie
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Arielle W
AW
Fein
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Yuo-Yu
YY
Lee
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Ummara
U
Shah
From the Divisions of Rheumatology and Orthopedics, Hospital for Special Surgery; Weill Cornell Medical College; New York-Presbyterian Hospital; Columbia University College of Physicians and Surgeons, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.J.E. Roberts, BA, Medical Student, Weill Cornell Medical College; L.A. Mandl, MD, MPH, Assistant Attending Physician, Hospital for Special Surgery, and Assistant Research Professor of Medicine, and Assistant Research Professor of Public Health, Weill Cornell Medical College; E.P. Su, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor of Orthopedic Surgery, Weill Cornell Medical College; D.J. Mayman, MD, Associate Attending Orthopedic Surgeon, Hospital for Special Surgery, and Associate Professor in Orthopedic Surgery, Weill Cornell Medical College, and Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital, and Clinical Co-Director, Computer Assisted Surgery Center, Hospital for Special Surgery; M.P. Figgie, MD, Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery, and Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; A.W. Fein, BA, Research Coordinator, Hospital for Special Surgery, and Medical Student, Columbia University College of Physicians and Surgeons; Y. Lee, MS, Biostatistician, Healthcare Research Institute, Hospital for Special Surgery; U. Shah, MD, Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry; S.M. Goodman, MD, Associate Attending Physician, Hospital for Special Surgery, and Associate Professor of Medicine, Weill Cornell Medical College.
Susan M
SM
Goodman
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology*
ADVERSE EVENTS; ARTHROPLASTY; HIP; OSTEOARTHRITIS; SYSTEMIC LUPUS ERYTHEMATOSUS