Total hip arthroplasty for sickle cell osteonecrosis: guidelines for perioperative management

Abstract

The prognosis of sickle cell disease (SCD) has greatly improved in recent years, resulting in an increased number of patients reporting musculoskeletal complications such as osteonecrosis of the femoral head. Total hip arthroplasty (THA) can be utilized to alleviate the pain associated with this disease. Although it is well known that hip arthroplasty for avascular necrosis (AVN) in SCD may represent a challenge for the surgeon, complications are frequent, and no guidelines exist to prevent these complications. Because patients with SCD will frequently undergo THA, we thought it necessary to fulfil the need for guidance recommendations based on experience, evidence and agreement from the literature. For all these reasons this review proposes guidelines that provide clinicians with a document regarding management of patients with SCD in the period of time leading up to primary THA. The recommendations provide guidance that has been informed by the clinical expertise and experience of the authors and available literature. Although this is not a systematic review since some papers may have been published in languages other than English, our study population consisted of 5,868 patients, including 2,126 patients with SCD operated on for THA by the senior author in the same hospital during 40 years and 3,742 patients reported in the literature. Cite this article: EFORT Open Rev 2020;5:641-651. DOI: 10.1302/2058-5241.5.190073

A rare coexistence of ankylosing spondylitis and SCD: Pitfalls and challenges during THA

“…Complications after THA such as postoperative wound infections, Deep Vein Thrombosis (DVT), and Pulmonary Embolism (PE) and have been reported to be more frequent in patients with SCD [8]. Hence appropriate measures to prevent infection such as adequate perioperative antibiotics coverage and thromboprophylaxis are essential in a patient with SCD undergoing THA.…”

Bone tissue engineering for treating osteonecrosis of the femoral head

“…For example, abnormal or excessive erythrocytes in sickle cell disease or polycythemia vera can cause intravascular occlusion and ischemia of the femoral head. [54][55][56][57][58] Intravascular occlusion caused by the imbalance between the coagulation system and fibrinolysis system can also lead to ONFH, as seen in hemophilia and hypercoagulable states-related diseases. [59] Patients with some autoimmune diseases need to take corticosteroid for a long period, as seen in systemic lupus erythematosus, which makes them susceptible to ONFH.…”

Total Hip Arthroplasty in the Severely Narrowed Femoral Canal by a Fibular Strut Using Knee Arthroscopic Tools: A Case Report and Technical Note

“…Preparation of the femoral canal in the presence of dense sclerotic bone with medullary involvement during performance of a conversion total hip arthroplasty (THA) presents many operative challenges due to altered bone architecture. Such challenges are frequently encountered in management of Paget’s disease and Sickle cell disease 1 2) . Several techniques having both pros and cons have been published in an effort to determine the optimum strategy 1 2) .…”

“…Such challenges are frequently encountered in management of Paget’s disease and Sickle cell disease 1 2) . Several techniques having both pros and cons have been published in an effort to determine the optimum strategy 1 2) . An intramedullary fibular strut causes inevitable distortion of the anatomical framework of the proximal femur, adding an extra dimension of complexity to a conversion THA.…”