Abstract: OBJECTIVE: With the development of diagnosis and treatment technology, the survival rate of patients with systemic lupus erythematosus is significantly improved, resulting in an increasing number of patients with chronic complications such as osteonecrosis of the femoral head requiring total hip arthroplasty. This article systematically evaluated the complications of total hip arthroplasty in patients with systemic lupus erythematosus and compared the Harris score before and after operation.
METHODS: A computer search of PubMed, CNKI, Wanfang and Cochrane Library databases published from the inception of the database to August 31, 2020 for patients with systemic lupus erythematosus who underwent total hip arthroplasty was conducted. The literature quality was evaluated by the National Institute for Clinical excellence and Castle-Ottawa scale. Postoperative complications and Harris score after total hip arthroplasty were collected. Revman 5.3 software was used for statistical analysis.  
RESULTS: (1) A total of 20 articles were included, with 15 series studies and 5 control studies, containing 657 patients with systemic lupus erythematosus. Total hip arthroplasty was performed in 802 places, with the youngest age being 16 years old; average follow-up time was 53.3 months. (2) There were 235 complications after systemic lupus erythematosus + total hip arthroplasty. The top 5 included  blood transfusion 52 times (22.1%), deep venous thrombosis 21 times (8.9%), wound infection 18 times (7.7%), prosthesis dislocation 17 times (7.2%) and wound hematoma 16 times (6.8%). Compared with the control group, the risk of complications in systemic lupus erythematosus + total hip arthroplasty patients significantly increased (P < 0.001). (3) The mean Harris score increased from 43.7 preoperatively to 89.5 at last follow-up in systemic lupus erythematosus + total hip arthroplasty patients. (4) Meta-analysis results showed that Harris score was higher after operation than that before operation in systemic lupus erythematosus + total hip arthroplasty patients (MD=45.73, 95%CI:42.0-49.4, P < 0.01). There was no significant difference in Harris score between systemic lupus erythematosus + total hip arthroplasty patients and non-systemic lupus erythematosus + total hip arthroplasty patients (MD=-0.84, 95%CI:-2.1-0.41, P=0.19).
CONCLUSION: The main postoperative complications of systemic lupus erythematosus + total hip arthroplasty patients were bleeding, deep venous thrombosis and incision infection, and the postoperative hip function increased significantly. Therefore, total hip arthroplasty can be used as the choice of surgical treatment for patients with systemic lupus erythematosus combined with advanced avascular necrosis of the femoral head. However, the results need to be verified by large samples and prospective studies. 

Key words: joint, hip, systemic lupus erythematosus, arthroplasty, complication, femoral head necrosis, hip function, meta-analysis