title: Systemic Lupus Erythematosus Does Not Increase Risk of Adverse Events in the First 6 Months After Total Knee Arthroplasty.
abstract: BACKGROUND
  Increasing numbers of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA). Whether postsurgical adverse events (AEs) are higher in patients with SLE than patients with osteoarthritis (OA) is unknown.
  
  
  OBJECTIVE
  This study aims to compare AEs within 6 months of TKA.
  
  
  METHODS
  Patients in a single institution's arthroplasty and SLE registries who underwent TKA from 2007 to 2014 were eligible. SLE cases were matched 1:2 to OA on age, sex, year of TKA, and procedure type. AEs were collected through chart review and registry responses. Baseline characteristics were compared and regression analysis performed to determine predictors of AEs.
  
  
  RESULTS
  Fifty-two SLE TKA were matched to 104 OA TKA. There was no difference in follow-up between groups. SLE patients had more comorbidities (≥1 Charlson-Deyo comorbidity: SLE 38.4% vs. OA 17.3%; P-value < 0.001) and steroid use (preoperative [SLE 28.8% vs. OA 1.9%, P-value < 0.001] and perioperative "stress-dose" [30.8% vs. 2.9%, P-value = 0.01]). SLE patients did not experience more major (SLE 25.0% vs. OA 19.2%; P-value = 0.41), minor (15.4% vs. 10.6%; P-value = 0.39), or total (38.5% vs. 27.9%; P-value = 0.18) AEs. AEs were not increased among patients on stress-dose steroids. In a multiple logistic regression analysis controlling for comorbidities and diagnosis, neither SLE (OR 1.61, 95% CI 0.74-3.50) nor >1 comorbidity (OR 1.05, 95% CI 0.46-2.39) was an independent risk factor for AEs.
  
  
  CONCLUSIONS
  SLE is not an independent risk factor for increased AEs 6 months after TKA. Stress-dose steroid use does not heighten AE risk. These findings should inform recommendations for SLE patients considering TKA.
authors.affiliation: From the *Hospital for Special Surgery, New York, NY; †Columbia University College of Physicians and Surgeons, New York, NY; ‡Case Western Reserve University School of Medicine, Cleveland, OH; §St. George's University School of Medicine, New York, NY; ∥University of Illinois at Chicago College of Medicine, Chicago, IL; ¶Weill Cornell Medical College, New York, NY; and #Weill Cornell Graduate School of Medical Sciences, New York, NY.
authors.forename: Arielle W
authors.initials: AW
authors.lastname: Fein
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Figgie
authors.forename: Taylor R
authors.initials: TR
authors.lastname: Dodds
authors.forename: Joshua
authors.initials: J
authors.lastname: Wright-Chisem
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parks
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mandl
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Su
authors.forename: Jane E
authors.initials: JE
authors.lastname: Salmon
authors.forename: David J
authors.initials: DJ
authors.lastname: Mayman
authors.forename: Yuo-Yu
authors.initials: YY
authors.lastname: Lee
authors.forename: Mark P
authors.initials: MP
authors.lastname: Figgie
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goodman
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome