Total hip replacement in sickle cell disease

Abstract

We report on 35 total hip replacement arthroplasties in 28 patients with avascular necrosis of the femoral head secondary to sickle cell disease (SCD). There were 15 men and 13 women with a mean age of 27.5 years. In all patients Harris hip scores improved from a mean of 36 pre-operative to 86 post-operative. However, at a mean follow-up of 9.5 (5-15) years six hips failed due to symptomatic aseptic loosening and one due to late deep infection. Our results support the decision to offer the procedure for patients with arthritic hips secondary to SCD. It is important that patients and surgeons should be aware of the wide varieties of complications.Résumè Nous rapportons sur 35 arthroplasties totales de la hanche dans 28 malades avec nécrose avasculaire de la tête fémorale secondaire à drépanocytose. Il y avait 15 hommes et 13 femmes avec un âge moyen de 27.5 années. Dans tout le score de la hanche de Harris amélioré d'une moyenne de 36 préopératoire à 86 postopératoire. Cependant, à une suite moyenne de 9.5 (5-15) années six hanches ont manqué dû à descellement aseptique symptomatique et un dû à infection profonde tardive. Nos résultats supportent la décision d'offrir la procédure pour les malades avec les hanches arthritiques secondaire à drépanocyt-ose. C'est important que les malades et chirurgiens doivent être informés des variétés larges de complications. IntroductionAvascular necrosis of the femoral head is one of the significant complications affecting the musculoskeletal system in patients with sickle cell haemoglobinopathy [6]. The reported incidence of femoral head necrosis varies from less than 10% to more than 30% [15,23]. In many patients both hips and other bones are affected [8].Improved medical care of children with sickle cell disease (SCD) has led to prolonged life span. In these patients many young adults will be seeking treatment for avascular necrosis of the femoral head. Review of the literature showed few reports on hip replacement arthroplasties in SCD, with the number of patients ranging from one [9] to 30 [1] and a high complication rate [7,12,16,22]. The incidence of sickle cell haemoglobinopathies presents major health care problems in Bahrain [18]. The aim of this report is to present our experience, and the problems encountered, with total hip replacement in avascular necrosis of the femoral head in SCD patients. Patient and methodsThirty-seven total hip replacements were performed between 1984 and 1995 for 30 SCD patients with avascular necrosis of the femoral head. One patient moved from the region and another died 3 years after hip replacement from acute pulmonary crisis. Thirtyfive hips in 28 patients were available for follow-up. There were 15 men and 13 women with a mean age of 27.5 (19-42) years. Seven patients, five of whom were women, had bilateral hip replacements. The second side was replaced within 2 years of the first operation. The mean number of previous admission to hospital for medical problems related to SCD was 6.5 (range 3-22 admissions). Blood group was A...

Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review

“…The primary purpose of this literature review was to pool the reported results of total hip arthroplasty for osteonecrosis to assess the overall revision rates to help us determine whether the disease itself is an independent risk factor for revision. Specific questions addressed were: (1) whether revision rates differ based on associated risk factors and/or diseases for osteonecrosis; (2) whether revision rates have changed over time, based on the year of index procedure; and (3) whether reported outcomes differ based on the level of evidence of the study. Where appropriate, an attempt was made to analyse whether there were differences in gender distribution, types of fixation, and length of follow-up that may have contributed to any differences in the results between these groups.…”

Short term results of cementless total hip arthroplasty in sicklers

“…have reported an average operative time of 2.2 h and a mean operative blood loss of 1275 ml. 14 Blood loss encountered was also less due to shorter operative time, meticulous hemostasis while exposing and use of bone wax to seal the vascular sinusoids.…”

Revision hip arthroplasty in sickle cell disease

“…THA is effective for pain management in SCD, but has high rates of complications. 3 , 4 , 6 , 7 , 10 , 15 – 17 Complications like acute chest syndrome and vasoocclusive crisis are frequently encountered with arthroplasty procedures in SCD. The etiology of acute chest syndrome is multifactorial and includes infection, pulmonary infarction and pulmonary fat embolism.…”

“…Gunderson et al 10 reported a 27% complication rate in 11 patients in 7.5 years. Al-Mausawi et al 6 reported 6 aseptic and 1 septic revision in 35 hips in a 9.5-year period. Hanker and Amstutz 5 reported a 100% complication rate and 5 revisions in a series of 9 patients in 6.5 years.…”

“…Fractures and perforations are quite frequent. 5 , 6 , 11 , 18 , 20 This creates problems while using press-fit cementless stems. Preoperative planning and choosing a narrow stem can reduce the incidence of this complication.…”