Lupus and Total Knee Arthroplasty: A Systematic Review of Inpatient Outcomes

Abstract

Introduction An increasing number of people diagnosed with systemic lupus erythematosus (SLE) will undergo total knee arthroplasty (TKA) for end-stage knee osteoarthritis. The purpose of this systematic review was to assess the cumulative inpatient complications of those with SLE who underwent TKA in comparison to those without this diagnosis. Methods A thorough review of 3 databases was performed to evaluate all potential complications of those who underwent TKA with and without a diagnosis of SLE. Following the completion of our search and review of manuscripts, we found 4 studies that were included in this systematic review consisting of 55,381 arthroplasties in patients with a diagnosis of SLE with 12,835,627 arthroplasties in the comparison cohort. Results The SLE cohort had an overall higher complication rate (25% versus 22%; p = 0.001). This cohort had a higher chance of postoperative anemia (11.7 versus 10.6%; p = 0.001) and a subsequent need for transfusion (11.1 versus 10.1%; p = 0.001), prosthetic joint infection (0.17 versus 0.11%; p = 0.001), wound infection (0.13 versus 0.09%; p = 0.001), pneumonia (0.5 versus 0.34%; p = 0.001), and cerebrovascular accident (0.03 versus 0.01%; p = 0.001). Mortality risk was lower within the SLE cohort ((0.04 versus 0.06%; p = 0.047). There was no difference in the risk of acute kidney injury (p = 0.15), venous thromboembolic disease (p = 0.33), periprosthetic fracture (p = 0.23), prosthetic dislocation (p = 0.53), and myocardial infarction (p = 0.11). Discussion Our results show that a diagnosis of SLE confers a higher risk of overall complications and multiple specific complications. However, SLE patients had a lower rate of mortality. Furthermore, there were multiple complications that those with SLE were not found to have a higher risk of suffering. Future studies should focus on how to optimize the safety and efficacy of TKA in the short- and long-term outcomes of patients with a diagnosis of SLE.