Effect of Sickle Cell Trait on Total Hip Arthroplasty in a Matched Cohort
Timothy L Waters1, J Heath Wilder1, Bailey J Ross1
1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
Insights
Sickle cell trait (SCT) carriers face increased risks for systemic and joint complications after total hip arthroplasty (THA). Careful perioperative management is crucial to mitigate these risks in SCT patients undergoing THA.
Area of Science:
- Orthopedic Surgery
- Hematology
- Public Health
Background:
- The impact of sickle cell trait (SCT) carrier status on total hip arthroplasty (THA) outcomes remains unclear.
- This study investigates the association between SCT and short-term clinical outcomes after THA.
Purpose of the Study:
- To compare short-term clinical outcomes of THA in patients with SCT versus matched controls.
- To identify specific complications associated with SCT carrier status post-THA.
Main Methods:
- A retrospective cohort study using the PearlDiver database.
- Patients with SCT undergoing THA were matched 1:1 with controls based on age, gender, comorbidities, obesity, and region.
- Logistic regression was used to compare 30-day, 90-day, 1-year, and 2-year complication rates.
Main Results:
- SCT carriers showed higher rates of cerebrovascular accident, anemia, acute renal failure, pneumonia, sepsis, DVT, PE, and respiratory failure within 90 days.
- Significantly increased risk of periprosthetic joint infection (1- and 2-year) and prosthetic loosening (1-year) was observed in SCT carriers.
- 1646 patients were included in each cohort.
Conclusions:
- SCT carrier status is associated with significantly higher risks of systemic complications, periprosthetic joint infection, and prosthetic loosening after THA.
- Preventing hypoxia, acidosis, and dehydration during the perioperative period may reduce complication rates in SCT patients.
- Optimizing care for SCT patients undergoing THA is essential for improved outcomes.
Background:
It is unclear if sickle cell trait (SCT) carrier status conveys an increased risk for poor outcomes following total hip arthroplasty (THA). The purpose of this study is to compare short-term clinical outcomes of THA for patients with SCT vs matched controls.
Methods:
Patient records were queried from the PearlDiver database using International Classification of Diseases, Ninth and Tenth Revision and Current Procedural Terminology codes. Patients with SCT who underwent THA were matched 1:1 with controls across age, gender, Elixhauser Comorbidity Index, obesity, and US region. Thirty-day and 90-day rates of systemic complications and 1-year and 2-year rates of joint complications were compared with logistic regression.
Results:
In total, 1646 patients were assigned to each cohort. In the 30-day and 90-day postoperative periods, SCT carriers had a higher likelihood of cerebrovascular accident, anemia, acute renal failure, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, and respiratory failure (all P < .05). SCT carriers exhibited significantly higher risk of periprosthetic joint infection at both 1 (3.5% vs 2.1%; odds ratio [OR] 1.91, 95% confidence interval [CI] 1.22-2.99) and 2 years (3.7% vs 2.6%; OR 1.63, 95% CI 1.07-2.49) postoperatively. Prosthetic loosening was also significantly more likely for SCT carriers within 1 year (1.3% vs 0.3%; OR 4.49, 95% CI 1.75-13.86).
Conclusion:
Patients with SCT exhibited significantly higher risk for systemic complications, periprosthetic joint infection, and prosthetic loosening after THA. Increased perioperative efforts should be made to prevent hypoxia, acidosis, and dehydration, as these states increase red blood cell sickling, which may reduce complication rates and improve outcomes in patients with SCT.
