Background:Aseptic necrosis (AN) of bones is one of the most serious complications of systemic lupus erythematosus (SLE), which is characterized by multicomponent joint damage mainly in young people. Long-term observations show that two thirds of patients have multiple aseptic necrosis of bones, with the femoral head being most often affected. Obviously, caused by much strain on the hip joint. In this regard, total hip arthroplasty (THA) is an integral part of the treatment of SLE patients. Despite the fact that THA in these patients allows to achieve good functional outcomes, the amount of complications remains high.Objectives:To retrospectively analyze the outcomes and structure of complications to determine the tactics of perioperative management of patients with SLE.Methods:The retrospective group included patients over 18 years of age with a reliable diagnosis of SLE, established according to the classification criteria (SLICC, 2012, ACR, 1997). 123 THA were performed in 77 patients. Outcomes and the structure of complications were analyzed for the period from 1998 to 2016 inclusive.Results:The period of hospital stay of patients was analyzed. Cementless fixation of the components of the endoprosthesis was used and the friction pair was metal-polyethyleneIn all cases. In 23 patients, additional fixation of the acetabular component with screws was performed, which indirectly indicates a poor quality of bone tissue. A more detailed analysis of these patients revealed a long period of glucocorticoid therapy (from 1.5 to 35 years). In 3 patients, during preparation for implantation of the femoral component, a femoral fracture occurred, which required using the cerclages. One patient also had a fracture of the acetabulum, which required the implantation of a Müller anti-protrusio ring. The above-described technical features led to increasing of the total time of surgery, which significantly increased the volume of blood loss. Thus, this required transfusions of blood components: fresh frozen plasma (FFP), erythrocyte suspension, as well as replenishment the circulating blood volume with colloidal solutions.Prevention of thromboembolism. All patients in the postoperative period underwent common measures of prevention of venous thromboembolism. The drugs of choice were calcium nadroparin (Fraxiparin) 0.3 or 0.6 ml subcutaneously - depending on body weight, respectively, or Dabigatran etexilate (Pradaxa) 220 mg per day, or rivaroxaban (Xarelto) 10 mg per day.Prevention of infectious complications. The first injection of antibiotic is carried out immediately before surgery achieve it’s maximum concentration in blood plasma just in the time of first incision. In the postoperative period, antibiotic therapy was carried out for at least 5 days. In 1 patient, the course of antibiotic therapy was prolonged and another broad-spectrum antibiotic was added due to a history of tuberculosis infection. Postoperative rehabilitation in patients with SLE met standard protocols: activation in bed and verticalization was carried out on day 1, standing with crutches and walking on day 2.Conclusion:During the period of hospital stay in the early postoperative period, not a single one thromboembolic event developed, as well as no cases of infectious complication occurred. There was one case of dislocation of the femoral component of the endoprosthesis, which was immediately repaired in the early postoperative period.Disclosure of Interests:None declared
Total hip arthroplasty for sickle cell osteonecrosis: guidelines for perioperative management