When Surgery Becomes Necessary for Lupus Patients

Lupus and Surgery: Hip Replacement

“A serious complication of systemic lupus is avascular necrosis of the hip. This can be caused by lupus disease, but also by the steroid medications used to treat lupus. Treatment may require hip replacement surgery,” says Ignacio Sanz, MD, a rheumatologist at the University of Rochester Medical Center in New York, and chair of the research committee for the Lupus Foundation of America.

Avascular necrosis of the hip (also called AVN or hip osteonecrosis) is caused by the loss of blood supply to the hip bone. This decreased blood supply causes bone cells to die and bone structure to weaken. It is an uncommon but very serious complication of lupus. Symptoms of hip involvement are pain and decreased movement. The risk factors for developing avascular necrosis in lupus patients can include steroid treatment and sometimes the presence of a lupus antibody called antiphospholipid antibody, which increases blood clotting. However, the exact role of antiphospholipid antibodies in the development of AVN is not yet known.

People with lupus tend to be younger than others who need hip replacement surgery and, frequently, those who need bilateral hip replacement. The surgery usually goes well and results in decreased pain and increased function. Other surgical procedures for avascular necrosis in patients with lupus can include bone grafts to stimulate the growth of new bone cells, and the removal of some bone marrow cells to encourage blood flow.

While these surgical treatments may be a necessary part of treatment for some patients with lupus, it’s important to remember that any surgery is stressful and stress can often be a trigger for lupus symptoms. You should carefully consider the pros and cons of any procedure your doctor may suggest. And remember that surgery for lupus complications generally goes well and is as successful for people with lupus as it would be for those without the disease.

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