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Noncemented Total Hip Arthroplasty in Sickle-Cell Disease: Long-Term Results
Imran Ilyas1, Husam A Alrumaih2, Samar Rabbani2
1Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.
Insights
Hip arthroplasty is a safe and effective treatment for avascular necrosis in sickle-cell disease (SCD) patients. Careful planning ensures successful outcomes with durable results from uncemented implants.
Area of Science:
- Orthopedic surgery
- Hematology
- Biomaterials science
Background:
- Avascular necrosis of the femoral head is a common complication of sickle-cell disease (SCD).
- Surgical intervention for SCD-related avascular necrosis presents unique technical challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of uncemented hip arthroplasty in patients with SCD.
- To assess long-term outcomes and complication rates of this procedure in the SCD population.
Main Methods:
- A retrospective study of 101 patients (133 hips) undergoing uncemented hip arthroplasty for SCD-related avascular necrosis between 2000 and 2012.
- All patients received uncemented femoral stems and acetabular shells.
- Follow-up ranged from 5 to 17 years (mean 14.59 years).
Main Results:
- Significant improvement in hip pain, range of motion, and function post-surgery.
- 10-year survivorship was 98%.
- Complication rates included intraoperative fractures (4.5%), infections (6.77%), aseptic shell failure (0.75%), aseptic stem failure (0.75%), and heterotopic ossification (3.76%).
Conclusions:
- Hip arthroplasty is a safe and effective procedure for SCD patients when complications are considered.
- Careful preoperative and postoperative planning is crucial for successful outcomes.
- Uncemented implants demonstrate durable long-term results in this patient cohort.
Background:
Avascular necrosis of the femoral head is a well-known sequela of sickle-cell disease (SCD) requiring a surgical intervention that comes with technical challenges.
Methods:
Uncemented hip arthroplasty for avascular necrosis of the femoral head due to SCD was carried out for 101 patients (133 hips) between 2000 and 2012. The duration of follow-up ranged from 5 to 17 years (mean, 14.59 years). All patients received a noncemented femoral stem and a noncemented acetabular shell.
Results:
After surgery, all patients showed improvement in their hip scores for pain, range of motion, and function. The 10-year survivorship was 98%. There were 6 intraoperative fractures of the proximal femur (4.5%), 4 superficial and 5 deep infections (6.77%), 1 aseptic shell failure (0.75%), and 1 aseptic femoral stem failure (0.75%). Brooker grade IV heterotopic ossification developed in 5 hips (3.76%).
Conclusion:
Hip arthroplasty in SCD is now a safe and effective procedure when the high rate of complications associated with this disease is given full consideration. With careful preoperative and postoperative planning, a highly successful outcome can be achieved. Noncemented shells and noncemented stems have shown durable long-term results.
