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Osteonecrosis of the hip in the sickle-cell diseases. Treatment and complications
1Southern California Orthopedic and Sports Medical Group, Van Nuys 91405-3641.
Insights
Hip arthroplasty in patients with sickle cell disease and osteonecrosis yields poor outcomes. High complication rates and early failure necessitate careful consideration for these surgical procedures.
Area of Science:
- Orthopedic Surgery
- Hematology
- Bone Diseases
Background:
- Sickle cell disease (SCD) and sickle cell trait (SCT) can lead to osteonecrosis of the femoral head.
- Surgical interventions like hip arthroplasty are sometimes considered for managing femoral head osteonecrosis in these patients.
Observation:
- This study reviewed nine patients with SCD or SCT and femoral head osteonecrosis who underwent hip arthroplasty or other surgical procedures.
- Follow-up averaged 6.5 years, revealing a high incidence of complications.
Findings:
- Five of eight hip arthroplasties required revision or excision due to mechanical loosening, sepsis, or prosthetic stem fracture.
- All patients experienced significant perioperative blood loss, prolonged hospital stays, and medical/surgical complications, irrespective of SCD/SCT severity.
- Survivorship analysis predicted a 50% failure rate by 5.4 years postoperatively.
Implications:
- Hip arthroplasty in patients with sickle cell disease and osteonecrosis is associated with a high failure rate and severe complications.
- These findings suggest that current surgical approaches may not be optimal for this patient population.
- Further research is needed to explore alternative or modified treatment strategies for femoral head osteonecrosis in sickle cell patients.
Abstract:
The results of arthroplasty of the hip and other surgical procedures that were performed in nine patients who had sickle-cell disease or sickle-cell trait and osteonecrosis of the femoral head were not very satisfactory. After an average duration of follow-up of 6.5 years (range, two to 25.7 years), the complications were many and severe. Of eight arthroplasties that were done for replacement of a joint, five required early revision or excision: two, because of mechanical loosening; two, because of sepsis; and one, due to a fracture of the prosthetic stem. There was excessive perioperative blood loss, prolonged hospitalization, and medical or surgical complications in all patients, including the three who had sickle-cell trait and only slight manifestations of systemic disease. A survivorship analysis of this series indicated that a failure rate of 50 per cent could be expected by 5.4 years postoperatively.