Lupus and Joint Replacement Surgery

Medically Reviewed by Sabrina Felson, MD on March 09, 2024
5 min read

If you’ve got lupus, chances are joint pain is one of your symptoms. The good news is that many people with this chronic autoimmune disease can keep joint pain in check with medication and exercise. But if your joint pain is out of control and interferes with your daily activities, joint replacement surgery may be the solution.

Inflammation typically causes joint pain linked to lupus. Inflammation is your body’s natural response if you’re fighting an infection or injury. If you have lupus, inflammation happens because your immune system mistakes healthy tissue for a foreign invader. Inflammation not only causes pain, but also swelling, tenderness, and stiffness in your joints. This is called lupus arthritis.

Medication that’s used to treat lupus also can harm your joints. Doctors often prescribe steroids, such as prednisone, to treat the inflammation that leads to joint pain and swelling. But these drugs can cause bone tissue death (osteonecrosis) when you take high doses for a long time. Osteonecrosis affects about 10% of people with lupus.

Before you think about joint replacement surgery for lupus arthritis, you may try other treatments, including weight loss, physical therapy, and medication.

Besides steroids, your doctor may prescribe other drugs to treat joint pain. These include:

If none of these treatments work to control your joint pain, joint replacement surgery may be an option.

There may be other reasons to think about surgery. You may have difficulty walking, climbing stairs, and sleeping. And when you’re in this much pain, you probably won’t move around much during the day. This causes your muscles to lose strength. Weak muscles, in turn, can worsen joint pain.

During total joint replacement, a surgeon removes your damaged joint and replaces it with a metal, plastic, or ceramic device. The new joint eases the pain that a damaged joint causes and helps it move as a normal, healthy joint would. Other joints, including the wrist or ankle, can be replaced, but hip and knee replacements are most common.

Your procedure will take place at a hospital or an outpatient surgery center. Depending on the type of replacement surgery you’re having, your surgeon may be able to use a less invasive technique that needs fewer incisions. This could mean a quicker recovery for you. Your doctor will let you know if this type of surgery may be right for you.

In the past, joint replacement wasn’t widely recommended for people with lupus. This was because of fears about possible complications. For example, research has shown that 43% of people with lupus had complications such as infection after major surgery. In contrast, this happened for 30% of people who did not have lupus. For joint replacement, research found that 10% to 35% of lupus patients have a higher risk of deep vein thrombosis (a blood clot in a deep vein, usually in the leg) after surgery.

Other findings are more positive. One small study found that patients with lupus had more pain before their hip or knee replacement than patients with osteoarthritis who had the surgery. Two years later, however, the two groups had similar levels of joint function and pain. In other research, people with lupus who had elective joint replacement were no more likely to die than those without the disease.

The type of joint replacement may affect outcomes. Research published in Clinics in Orthopedic Surgery in 2020 found that people with lupus who received total hip replacement had more complications, including stroke, pneumonia, and infection, than those without lupus who received this surgery. But lupus patients who got total knee replacements didn’t have more complications.

Joint replacement is major surgery. If you’re thinking about it, discuss it with your rheumatologist. People with lupus may be at increased risk for certain complications.

To help ensure a successful joint replacement surgery, your orthopedic surgeon should work with your rheumatologist. They will discuss your medications and how to track your body functions during and after surgery.

If you take medication to prevent blood clots, you may need to stop it before your operation to help prevent excessive bleeding during surgery and then restart it. If you take a steroid, your doctor may ask you to pause it or adjust your dosage prior to surgery to help lessen your risk for complications. If you take the lupus medication belimumab (Benlysta) or rituximab (Rituxan), it’s safe to stop taking it temporarily before total hip or knee replacement unless you need it to prevent organ damage.

It’s also a good idea for your rheumatologist to check your overall health to make sure that you are ready for joint replacement surgery. Before surgery, you also may need blood and urine tests and an EKG and echocardiogram to check your heart function.

After the procedure, your care team will watch for blood clots and track your other body functions. If you had hip or knee replacement, you’ll typically be in the hospital for about 4 days after surgery.

Before your discharge date, ask your surgeon whether it’s best for you to go home or to spend time at a rehab center. If you think you’ll need help with household chores, ask if you can get a home health aide. Make sure that your home is free of clutter so you can walk safely or use equipment such as a wheelchair. Remove rugs that may cause you to trip, and put a non-slip bath mat in your bathtub or shower.

With proper planning and teamwork between you and your doctors, you’ll have the best odds of a successful joint replacement surgery.