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Total hip arthroplasty in sickle cell disease: A systematic review and meta-analysis of functional outcomes and
Ankush Mohabey1, Jomon De Joseph2, Felista Karen Joseph3
1Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India.
Insights
Total hip arthroplasty (THA) in sickle cell disease (SCD) patients improves function but carries risks. Multidisciplinary care is crucial for optimizing outcomes in these younger patients undergoing hip replacement.
Area of Science:
- Orthopedics
- Hematology
- Systematic Review & Meta-Analysis
Background:
- Sickle cell disease (SCD) significantly increases avascular necrosis (AVN) risk, often leading to early total hip arthroplasty (THA).
- Patients with SCD typically undergo THA at a younger age compared to those with primary osteoarthritis.
- This study systematically reviews functional outcomes, complications, and blood loss in SCD patients receiving THA.
Purpose of the Study:
- To evaluate functional outcomes after THA in patients with SCD.
- To assess surgical complications associated with THA in this population.
- To analyze intraoperative blood loss during THA for SCD patients.
Main Methods:
- A comprehensive systematic search of major databases (Cochrane, Web of Science, Scopus, EMBASE, PubMed) was performed.
- Included studies focused on THA in patients with sickle cell disease.
- Functional outcomes (Oxford Hip Score, Harris Hip Score), complications, revision rates, and blood loss were analyzed using pooled statistical methods.
Main Results:
- Analysis of 25 studies revealed significant improvements in functional outcomes, evidenced by a mean Harris Hip Score increase of 6.96.
- Common complications included aseptic loosening (12%), revision surgery (11%), and heterotopic ossification (8%).
- Mean intraoperative blood loss was 1059.24 ml, with a mean patient age between 20-35 years.
Conclusions:
- Total hip arthroplasty in sickle cell patients presents significant challenges and a high complication risk.
- Despite risks, THA can lead to substantial functional improvements for SCD patients.
- Implementing multidisciplinary perioperative care is essential for optimizing THA outcomes in this high-risk group.
Background:
Sickle cell disease (SCD) is a significant risk factor for avascular necrosis (AVN) of the femoral head, often necessitating total hip arthroplasty (THA) at a younger age than patients with primary osteoarthritis. This systematic review and meta-analysis aimed to evaluate the functional outcomes, surgical complications, and intraoperative blood loss in SCD patients undergoing THA.
Materials And Methods:
A systematic search of databases, including Cochrane, Web of Science, Scopus, EMBASE, and PubMed, was conducted on November 5, 2024. Studies involving sickle cell patients who underwent THA were included. Functional outcomes were assessed using scoring systems such as the Oxford Hip Score (OHS) and Harris Hip Score (HHS). Postoperative complications, revision rates, and intraoperative blood loss were also analyzed. Statistical analyses were conducted to derive pooled estimates and confidence intervals. PROSPERO ID: CRD42024609360.
Results:
A total of 25 studies met the inclusion criteria, comprising both retrospective and prospective studies. The pooled analysis revealed a significant improvement in functional outcomes, with a mean HHS increase of 6.96 (95 % CI: 5.56-8.35). Mean age of patients ranged from 20 to 35 years. Pooled estimate of complications included aseptic loosening (12 %), dislocation (1 %), heterotopic ossification (8 %), iatrogenic fracture (8 %), infection (8 %), osteolysis (8 %), periprosthetic fractures (8 %), revision surgery (11 %), sickle cell crisis (5 %), and thromboembolism (2 %). The mean blood loss was 1059.24 ml.
Conclusion:
THA in sickle cell patients presents considerable challenges with a high risk of complications. Despite these challenges, THA can lead to functional improvement. Given the heightened risk profile, multidisciplinary perioperative care strategies are essential to optimize outcomes.
