Background:Sickle cell (SC) disease leading to endarteritis induces skeletal changes in the form of osteitis, sclerosis of femoral canal and osteonecrosis of the femoral head. All these make total hip arthroplasty (THA) difficult and prolonged. There is increased risk of infection, SC crisis and increased complication rate. Our paper aims to highlight preoperative, intraoperative and postoperative hurdles encountered in performing THA in sicklers and the short term outcome using cementless implants.Materials and Methods:Thirty-nine patients with SC disease, who had osteonecrosis of the femoral head, were operated between 2007 and 2011. The mean age of patients was 22 years (range 13–49 years). There were twenty eight females and 11 males. Bilateral cementless total hip replacement (THR) was performed in 11 patients (22 hips) and in the rest unilateral (28 hips). Preoperative and postoperative modified Harris hip score was evaluated. The average followup was 3.8 years (range 2-6 years).Results:The average operating time was 96 min (range 88–148 min). The average blood loss was 880 ml (range 650–1200 ml). The average intraoperative blood transfused was 2.3 units (range 2–5 units). All patients showed an improvement in Harris hip score from 42 points preoperatively to 92 points at latest followup. Intraoperatively, one patient had a periprosthetic fracture. Six patients developed acute SC crisis and were managed in intensive care unit. Three patients developed wound hematoma. Three patients developed limb length discrepancy less than 1 cm. None had early or late dislocations, infection, heterotopic ossification, sciatic nerve palsy and aseptic loosening.Conclusion:THA in sicklers involves considerable challenge for the orthopedic surgeon. Management requires a multidisciplinary approach involving the anesthetist, hematologist and the orthopedic surgeon. Contrary to previous reports, THA in sicklers now has a predictable outcome especially with the use of cementless implants.
Lumbar spinal stenosis is most common entity coming to spine out-patient department which may present with complaint of back pain with lower limbs neurogenic claudication, caused by degenerative disc conditions or to facet joint hypertrophy or ligamentum flavum thickening. We represent a case report of a patient suffering from low back pain with worsening neurogenic claudication. Imaging showing a cystic lesion at L3-4 spinal level with no lysthesis pinching the traversing nerve root who undervent minimal invasive tubular transforaminal lumbar interbody fusion. Intraoperatively, a cystic mass originating from ligament flavum with yellow jelly fluid adherent to dura and no communication with subarachnoid space or facet joint was found. Histologically, these cysts represent a distinct entity different from synovial cysts in terms of devoid of epethelial lining. To differentiate in cyst outlines and origin is very helpful in preoperative planning as even complete removal of ligamentum flavum cyst does not damage the facet joint and no fixation is required in these cases as compared to facetal cyst which represents instability and fixation is mandatory.
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