Total hip arthroplasty in osteonecrosis secondary to sickle cell disease

Abstract

Background Sickle cell disease (SCD) is a multisystem disease, and the predominant articular manifestation is osteonecrosis (ON). Total hip arthroplasty (THA) is technically challenging, and the complication rates are high. In this retrospective study, we have analysed the outcome of THA in a cohort of patients with SCD at our institution. Materials and methods We identified 34 THAs between 1999 and 2016 in 30 patients (mean age 37 years) from our SCD database. Co-morbidities, both sickle and non-sickle-related, were documented. Complications and indications for revision surgery were analysed. Results An uncemented prosthesis was predominantly used. The mean follow-up was 10.5 years (range 1-18). Six patients had revision surgery (17.6%), 2 (5.8%) for Prosthetic Joint Infection (PJI), and 4 (11.7%) for osteolysis of the acetabular component. Conclusion Our revision rates were comparable to the published literature. Our combined sickle cell clinic and the coordinated multidisciplinary management have been successful in reducing morbidity.

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

“…One hundred and sixty‐eight reports discuss, in variable detail, the perioperative care of SCD patients. A multidisciplinary collaboration and communication between the surgeon, anesthetist, hematologist and blood bank specialist are universally considered to be mandatory, although specific study data is not available to support this unanimous recommendation . When required, the preemptive and planned coordination with an ICU team for post‐operative admission and care is suggested .…”

“…The role for antibioprophylaxis is discussed by many, and two strategies seem to co‐exist in the literature. There are authors recommending prophylaxis according to type of surgery, and others adapting it to the individual patients' medical histories . As a standout, splenectomy needs specific considerations, including preoperative immunizations against encapsulated bacteria, as in the context of asplenia .…”

“…Some authors advocate for preoperative transfusion without giving a threshold, despite evidence from the abovementioned RCTs. Exchange transfusions (manual and automated) for a leve of HbS <30% is recommended for high risk surgery either preoperatively, or on cardiopulmonary bypass . In cardiac pulmonary bypass, some authors suggest a stricter HbS limit of <5% .…”

“…All anesthesia techniques and standard drugs are deemed appropriate and safe for the use in SCD patients according to many . Some recommend general anesthesia as a preferred strategy whereas others suggest locoregional anesthesia with proper sedation when possible . Two groups, in reviews, suggest avoiding using epinephrine in local anesthesia .…”

“…Per standard anesthetic care, blood pressure, cardiac rhythm and rate and oxygenation are monitored strictly to avoid hypoxia . Some groups perform more invasive systematic monitoring such as the continuous measurement of central venous pressure, arterial blood pressure, regular arterial blood gas exchange and/or urine output determination (by Foley catheterization) . One case report recommends against Foley catheter insertion, due to the risk of infection .…”