Simultaneous bilateral total hip arthroplasty in sickle cell disease

Area of Science:

• Orthopedic Surgery
• Hematology

Background:

• Avascular necrosis of the femoral head is a debilitating complication of sickle cell disease.
• Total hip arthroplasty is a potential treatment option for advanced femoral head necrosis.

Purpose of the Study:

• To evaluate the outcomes of simultaneous bilateral uncemented total hip arthroplasty in patients with sickle cell disease.
• To assess complications and functional improvements following the procedure.

Main Methods:

• 18 consecutive patients (36 hips) with sickle cell disease underwent simultaneous bilateral uncemented total hip arthroplasty.
• Patients were followed for a mean of 5.7 years (range, 2-10 years).
• Postoperative hip scores for pain, range of motion, and function were compared to preoperative scores.

Main Results:

• All patients demonstrated significant improvement in hip scores postoperatively.
• Two immediate complications related to sickling, one intraoperative fracture, and two infections occurred.
• No femoral stem loosening was observed, but one case of protrusio acetabuli and one acetabular cup revision for instability were noted.
• Heterotopic ossification developed in two patients.

Conclusions:

• Simultaneous bilateral total hip arthroplasty is a viable option for select sickle cell disease patients with avascular necrosis.
• Adequate perioperative and postoperative hydration and ventilation are essential for minimizing complications.