Total hip replacement in sickle cell disease.

Area of Science:

• Orthopedic Surgery
• Hematology
• Rheumatology

Background:

• Sickle cell disease (SCD) frequently causes avascular necrosis of the femoral head, leading to hip pain and dysfunction.
• Avascular necrosis of the femoral head in SCD patients often necessitates surgical intervention.
• Total hip replacement is a potential treatment option for end-stage hip disease in SCD patients.

Purpose of the Study:

• To evaluate the outcomes of total hip replacement arthroplasty in patients with avascular necrosis of the femoral head secondary to sickle cell disease.
• To assess functional improvements and long-term complications following hip replacement in this patient population.

Main Methods:

• Retrospective review of 35 total hip replacement arthroplasties in 28 patients with SCD-related avascular necrosis of the femoral head.
• Analysis of pre-operative and post-operative Harris hip scores.
• Evaluation of long-term follow-up data, including complications such as aseptic loosening and infection.

Main Results:

• All patients experienced significant improvement in Harris hip scores, from a mean of 36 pre-operatively to 86 post-operatively.
• At a mean follow-up of 9.5 years, seven hips (20%) failed: six due to aseptic loosening and one due to late deep infection.
• The study included 15 men and 13 women with a mean age of 27.5 years.

Conclusions:

• Total hip replacement can effectively improve hip function in patients suffering from avascular necrosis of the femoral head due to sickle cell disease.
• Patients and surgeons must be aware of the potential for serious complications, including aseptic loosening and infection, following hip arthroplasty in this population.
• The findings support offering total hip replacement for arthritic hips secondary to SCD, with careful consideration of risks and benefits.