Joint Replacement

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Lupus can attack any part of the body, including joints and the connective tissue that make the joints work properly. Management of the disease can keep those joints healthy and operating well in many people. But, some people with lupus may need joint replacement surgery to restore their quality of life.

What causes joint destruction in people with lupus?

Many aspects of lupus can cause bone and joint damage. The steroids used to treat many of the symptoms of lupus often come with side effects. One of those side effects is osteonecrosis, which is the medical term for bone death caused by the poor blood supply. Between three percent and 30 percent of people with lupus develop osteonecrosis.1Osteoporosis is also common in people with lupus, sometimes due to steroids and sometimes due to lack of exercise caused by fatigue, pain, arthritis, and the need to avoid sunlight.

Osteoarthritis, or deterioration of the joints, can also develop along with lupus.

While any joint in the body can be impacted by lupus, the joints most often replaced are the hips and knees.2

What is joint replacement surgery?

Total joint replacement is a major surgery in which a damaged joint is removed and replaced with a metal, plastic, or ceramic joint. This new joint restores normal movement and range of motion and reduces the pain felt due to damaged joints.

Is joint replacement surgery safe for people with lupus?

Doctors once thought that joint replacement surgery for people with lupus should be avoided due to the high rate of complications. However, surgical outcomes for people with lupus have been improving.1

One small study in New York found that people with lupus had much worse pain and less function compared to those without lupus before surgery. However, two years after total hip replacement and total knee replacement, the people with lupus reported similar levels of pain and function.2

The study also found that those with lupus who needed hip replacement often had osteonecrosis. They required knee replacement for osteoarthritis similar to middle-aged patients who were overweight.3

On the other hand, a large study in Taiwan found that people with lupus experienced much higher rates of serious complications in the 30 days after major surgery. The most common problems were kidney failure, pneumonia, pulmonary embolism (blood clot in the lungs), septicemia (blood poisoning), and stroke (blood clot in the brain).4

Special surgical precautions for people with lupus

While surgery outcomes are improving, people with lupus tend to be sicker and more vulnerable to complications after surgery than others. That is why anyone with lupus who undergoes surgery must be monitored closely before, during, and after the procedures.3

Any major surgery should be planned as far ahead of time as possible and coordinated with the person’s rheumatologist. This gives the person time to stop or start taking medications that may complicate the surgery itself or recovery.

During surgery, anyone with lupus must be watched closely to avoid organ damage and blood clots. After surgery, 10 percent to 35 percent of people with lupus have an increased risk of deep vein thrombosis or blood clots in the legs.3

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