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Cementless total hip replacements in sickle cell disease
Christopher M Jack1, Jo Howard1, Emad S Aziz1
1University Hospital Southampton, Southampton, Hampshire - UK.
Insights
Uncemented total hip arthroplasty (THA) with ceramic-on-ceramic bearings is a safe and reliable option for sickle cell disease (SCD) patients, showing no implant loosening or osteolysis in a 5-year follow-up.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Hematology
Background:
- Sickle cell disease (SCD) impacts numerous individuals, with a high incidence of femoral head osteonecrosis.
- Cemented acetabular components demonstrate suboptimal outcomes in SCD patients, marked by significant osteolysis rates.
- Uncemented total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) bearings presents an alternative approach.
Purpose of the Study:
- To evaluate the efficacy and safety of uncemented THA using CoC bearings in patients with SCD.
- To assess the long-term outcomes, including osteolysis, migration, and loosening, of these implants.
Main Methods:
- A cohort of 40 SCD patients underwent 52 primary THAs between 2002 and the present.
- Preoperative blood transfusions were administered to most patients.
- Uncemented implants (S-ROM, Solutions, AML) were utilized, with some cases requiring femoral drilling.
Main Results:
- All uncemented components achieved osseointegration.
- No instances of radiographic osteolysis, migration, or loosening were observed.
- The average follow-up period was 5 years, ranging from 2 to 10.1 years.
Conclusions:
- Uncemented THA with CoC bearings is a safe and effective procedure for SCD patients.
- A multidisciplinary team approach is crucial for successful outcomes.
- This approach minimizes complications like osteolysis and implant failure.
Background:
Sickle cell disease (SCD) affects around 80,000 people in the USA and 12,000 in the UK. Up to 40% of patients will get osteonecrosis of the femoral head. Cemented acetabular components yield poor results with the rate of osteolysis ranging from 13.5 to 46%. We report on a consecutive cohort of patients with SCD who underwent uncemented THA with ceramic-on-ceramic (CoC) bearings.
Methods:
Since 2002 52 primary THAs were carried out in 40 patients. The average age was 36.1 years (17-54). 48 cases had exchange blood transfusion preoperatively and 3 had top-up transfusions.An S-ROM was used in 47 hips a Solutions stem in 4 hips and an AML in 1. It was necessary to drill the femur during 12 hips. There were 5 intra-operative peri-prosthetic fractures. 2 dislocations were observed. 2 superficial infections were detected.
Results:
All components have in-grown. There have been no cases of radiographic osteolysis, migration or loosening of the hip with average 5-year (2-10.1) follow-up.
Conclusions:
The combination of a multidisciplinary team approach and uncemented implants, with ceramic-on-ceramic bearings used, has made THA in patients with SCD a safe and reliable procedure in our hospital.
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