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Total hip replacement among sickle cell patients in a low-income country–Yemen

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Abstract

Purpose

Sickle cell patients presented with progressive hip pain and limitation of daily activities, as evidenced by low preoperative hip scores and failed conservative therapy. Management of femoral head avascular necrosis (AVN) using total hip replacement (THR) in sickle cell disease (SCD) is widespread in developed countries, but it is still in its initiation stage in developing countries. The outcome of using cementless THR among SCD patients is still unknown with lack of published studies from regional countries. This study aimed to evaluate the outcome of using cementless primary THR among patients with sickle cell disease with end-stage hip avascular necrosis in Yemen.

Methods

Thirty cementless primary total hip arthroplasty (THA) were performed for AVN of the femoral head in 27 sickle cell patients, at Al.-Thawra Modern General Hospital-Sana’a, Yemen, from January 2018 to December 2022.

Results

The mean age of the patients was 27 ± five years (ranged 18–37 years) with a male to female ratio was 3:1. Steinberg staging for hip AVN was stage IV, one patient (3%); stage VI, thirteen patients (45%); and stage V, sixteen patients (51%). THR was on right side 14 (52%), left side 10 (37%), and bilateral 3 (11%). The implant used was ceramic on polyethylene acetabular liner. All patients showed improvement in Harris hip score from preoperative mean hip score was 25 ± 8 points to postoperative mean hip score was 88 ± 6 points at the last follow-up. Mean of the length of stay in hospital was 12.7 ± eight days (ranged from 4 to 32 days); the mean operating time was 107 ± 23 min. Three cases had superficial wound infection; four patients had five intraoperative fractures; two cases had pulmonary complications; one case had abdominal crisis. All patients had postoperative leg length discrepancy less than 2 cm. None had deep infection, nerve injury, wound hematoma, aseptic loosing, dislocation, DVT, heterotopic ossification, or death.

Conclusion

THR in SCD has a good outcome using cementless THA with a low rate of complication in Yemen, a developing country.

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Data availability

When needed.

Code availability

Not applicable.

Abbreviations

AVN:

Avascular necrosis

DVT:

Deep venous thrombosis

F:

Female

Hb:

Hemoglobin

HHS:

Harris hip score

LLD:

Leg length discrepancy

M:

Male

SCD:

Sickle cell disease

THA:

Total hip arthroplasty

THR:

Total hip replacement

TMGH:

Al-Thawra Modern General Hospital

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Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen

    Anwar Abdulqader Mughalles & Kawkab Mohammed Al-Haddad

  2. Al-Thawra Modern General Hospital, Sana’a, Yemen

    Anwar Abdulqader Mughalles, Ghamdan Gamal Alkholidy, Mohammed Saleh AlSaifi & Wael Mohamed Al-Gabaly

  3. Faculty of Medicine, 21 September University of Medical and Applied Sciences, Sana’a, Yemen

    Mohammed Saleh AlSaifi

Authors
  1. Anwar Abdulqader Mughalles
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  2. Ghamdan Gamal Alkholidy
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  3. Mohammed Saleh AlSaifi
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  4. Wael Mohamed Al-Gabaly
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  5. Kawkab Mohammed Al-Haddad
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by AAM, GGA, MSA, WMA, and KMA. The first draft of the manuscript was written by AAM and GGA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ghamdan Gamal Alkholidy.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki, the WHO code for health, and Article (5) of the Statistics Yemeni Law No. (28) for the year 1995. Approval was granted by the Ethics Committee of the Faculty of Medicine, Sana’a University-Yemen on 02/02/2018.

Informed consent

Informed consent was obtained from all individual participants included in the study. The patients’ consent file is attached as an attached document with submitted documents.

Conflict of interest

The authors declare no competing interests.

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Mughalles, A.A., Alkholidy, G.G., AlSaifi, M.S. et al. Total hip replacement among sickle cell patients in a low-income country–Yemen. International Orthopaedics (SICOT) 48, 923–930 (2024). https://doi.org/10.1007/s00264-023-06049-5

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  • DOI: https://doi.org/10.1007/s00264-023-06049-5

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