Total THA in adult osteonecrosis related to sickle cell disease

Most previous studies of THA in sickle cell disease report high risks of medical and orthopaedic complications, including infections and a higher incidence of failure than observed after THA for osteonecrosis related to other conditions. Based on our experience (1245 orthopaedic procedures during the last 25 years), we questioned these conclusions and retrospectively reviewed 312 arthroplasties performed in 244 patients with sickle cell disease. The mean age of the 126 women and 118 men at the time of surgery was 32 years. The minimum followup was 5 years (mean, 13 years; range, 5-25 years). We revised 10 hips (3%) for infection at a mean 11 years (range, 7-15 years) after the primary procedure and revised 21 cups (8%) and 17 stems (5%) for aseptic loosening at a mean of 14 years. We observed medical complications after 85 operations (27%) and orthopaedic complications in 42 cases (13%). Although THA carries a high risk of complication in patients with sickle cell disease, the benefits for the patient are substantial, and the risk of revision for loosening or infection appeared less than described in previous literature.

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.