Total hip replacement in sickle cell disorder: A preliminary report of challenges and early outcome of 21 consecutive patients

Abstract

Objective: The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional  outcome and observe complications of treatment, recommend ways of improving outcome.

Patients and Methods: Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients’ evaluation was performed at two different times of follow‑up (1 and 5 years, respectively).

Results: Twenty‑one patients were available at 1 year as well as 5‑year follow‑up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46–54. The average liner size was 49.43 with a range of 46–54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6–8. The offset used in all the patients was standard All the patients had 1–2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1.

Conclusion: THR is a veritable means of treatment of patients with avascular  necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits.

Keywords: Arthroplasty, challenges, outcome, sickle cell disorder, total hip replacement