Whether Lupus patients have worse outcome of core decompression of Hip osteonecrosis?

Abstract

Abstract Background: Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to determine the probable outcome measures of core decompression in SLE patients. Methods: In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients’ demographic characteristics, clinical data, drug history, comorbidities, laboratory findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients’ satisfaction with joint function according to the Oxford Hip score questionnaire were obtained. Results: In our study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. The sixty one and a half percent (61.5%) of patients had unsatisfactory joint performance. Third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphosphonate use (P <0.02). Among the 23 investigated cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41mg and 14.74mg respectively. Conclusions: The group of patients that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression in our study.