TOTAL HIP ARTHROPLASTY AS A TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD IN PATIENTS WHO HAVE SICKLE-CELL HAEMOGLOBINOPATHY

Abstract

We reviewed retrospectively the results of total hip arthroplasties that were performed at one institution in young patients who had different types of sickle-cell Haemoglobinopathies to ascertain whether this form of therapy for Osteonecrosis of the hip was appropriate.

MATERIAL-METHOD. Between 1991–2005, 40 patients (24 females-16 males) who have sickle-cell anaemia (12 pts) and microdrepanocytic disease (28 pts), underwent a THR (4 pts bilaterally).The average age at the time of the primary operation was 42.5 yrs (range 18–57 yrs). Cemented, hybrid or uncemented prostheses were used in all cases.

Usually 4–5 blood units are needed perioperatively. Prophylatic antibiotic therapy and anticoagulation treatment always is used.

RESULTS. At the follow-up one patient had died because of haematological complications while was in the hospital. Three others have died of unknown to us reasons. The mean follow-up was 6 yrs-7 mo.

Thirty-six hips re-evaluated and according the Harris Hip Score in 17 the result was excellent, in 15 good and in 4 fair.

The main problem, during the operation, was the difficulty to open the femoral canal, which was very narrow and in some cases completely closed and the bone cortex very dense.

One patient had a revision procedure in two stages for septic loosening seven years after the primary THR. Four patients had a revision procedure for aseptic loosening between one and ten years after the primary operation.

The more serious complications during the surgical intervention were fracture of the greater trochanter in four cases and fracture of the diaphysis of the femur in four, also, cases.

CONCLUSIONS. In this cohort of patients with the multiple medical problems and the frequent admissions, total hip arthroplasty offers a satisfactory solution to the hip problem. However accurate patient selection and carefull multidisciplinary pre-, intra-and post-operative approache is mandatory, including detailed pre-operative examination, close collaboration with the haematologist, pre-operative red blood cell exchange, perioperative use of antibiotics, intra-operative care for preventions of crises of sickling and finaly antibiotic therapy in cases of dental interventions or catheterisms