EARLY RESULTS OF TOTAL HIP REPLACEMENT IN SICKLE CELL DISEASE

Abstract

Introduction: The treatment of end stage hip osteonecrosis in patients with Sickle cell disease presents a unique set of challenges, with patients often needing arthroplasty in young adult life. Traditionally, this group of patients has a high incidence of complications and failure. We report the early results of THR in patients managed by the single hip surgeon working as part of the comprehensive Sickle Cell service.

Methods: Data was collected prospectively on all sickle patients undergoing THR at our institution. 18 patients underwent surgery with a mean age of 37 (range 25–63). There were 16 primary and 2 revisions. All patients were optimised pre-operatively with an exchange transfusion to ensure the HB SS < 30%, and all possible sites of sepsis were treated aggressively. All patients received uncemented implants with hard on hard bearings and broad-spectrum prophylactic intravenous antibiotics for 48 hours.

Results: 18 patients were followed up at a mean of 25 months. Despite technical challenges, all patients had a stable hip with good resolution of pain and radiographic evidence of bony ingrowth of all components. There were 3 minor intra-operative metaphyseal peri-prosthetic fractures, which all healed satisfactorily. There was a single early dislocation that has remained stable after closed reduction. There have been no superficial or deep infections.

Discussion: This study shows that THR can be performed safely in patients with sickle cell disease within the context of a multi-disciplinary team approach. Operative technique involves the use of long drills under image intensifier to prepare the femur safely and use of a modular uncemented system to address the mismatch between the metaphysis and the diaphysis.