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Total THA in Adult Osteonecrosis Related to Sickle Cell Disease

  • International Hip Society Symposium
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Most previous studies of THA in sickle cell disease report high risks of medical and orthopaedic complications, including infections and a higher incidence of failure than observed after THA for osteonecrosis related to other conditions. Based on our experience (1245 orthopaedic procedures during the last 25 years), we questioned these conclusions and retrospectively reviewed 312 arthroplasties performed in 244 patients with sickle cell disease. The mean age of the 126 women and 118 men at the time of surgery was 32 years. The minimum followup was 5 years (mean, 13 years; range, 5–25 years). We revised 10 hips (3%) for infection at a mean 11 years (range, 7–15 years) after the primary procedure and revised 21 cups (8%) and 17 stems (5%) for aseptic loosening at a mean of 14 years. We observed medical complications after 85 operations (27%) and orthopaedic complications in 42 cases (13%). Although THA carries a high risk of complication in patients with sickle cell disease, the benefits for the patient are substantial, and the risk of revision for loosening or infection appeared less than described in previous literature.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Acurio MT, Friedman RJ. Hip arthroplasty in patients with sickle-cell haemoglobinopathy. J Bone Joint Surg Br. 1992;74:367–371.

    PubMed  CAS  Google Scholar 

  2. Al-Mousawi F, Malki A, Al-Aradi A, Al-Bagali M, Al-Sadadi A, Booz MM. Total hip replacement in sickle cell disease. Int Orthop. 2002;26:157–161.

    Article  PubMed  CAS  Google Scholar 

  3. Babis GC, Soucacos PN. Effectiveness of total hip arthroplasty in the management of hip osteonecrosis. Orthop Clin North Am. 2004;35:359–364.

    Article  PubMed  Google Scholar 

  4. Bishop AR, Roberson JR, Eckman JR, Fleming LL. Total hip arthroplasty in patients who have sickle-cell hemoglobinopathy. J Bone Joint Surg Am. 1988;70:853–855.

    PubMed  CAS  Google Scholar 

  5. Brooker AF, Bowerman JW, Robinson RA, Riley Jr LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.

    PubMed  CAS  Google Scholar 

  6. Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV, McMahon RP, Bonds DR. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med. 1995;332:1317–1322.

    Article  PubMed  CAS  Google Scholar 

  7. Clarke HJ, Jinnah RH, Brooker AF, Michaelson JD. Total replacement of the hip for avascular necrosis in sickle cell disease. J Bone Joint Surg Br. 1989;71:465–470.

    PubMed  CAS  Google Scholar 

  8. Epps CH Jr, Bryant DD 3rd, Coles MJ, Castro O. Osteomyelitis in patients who have sickle-cell disease. Diagnosis and management. J Bone Joint Surg Am. 1991;73:1281–1294.

    PubMed  Google Scholar 

  9. Espehaug B, Engesaeter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty. Review of 10,905 primary cemented total hips replacements reported to the Norwegian arthroplasty register, 1987 to 1995. J Bone Joint Surg Br. 1997;79:590–595.

    Article  PubMed  CAS  Google Scholar 

  10. Firth PG, Head CA. Sickle cell disease and anesthesia. Anesthesiology. 2004;101:766–785.

    Article  PubMed  Google Scholar 

  11. Freedman KB, Brookenthal KR, Fitzgerald RH Jr, Williams S, Lonner JH. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am. 2000;82:929–938.

    PubMed  Google Scholar 

  12. Garden MS, Grant RE, Jebraili S. Perioperative complications in patients with sickle cell disease. An orthopedic perspective. Am J Orthop. 1996;25:353–356.

    PubMed  CAS  Google Scholar 

  13. Gruen TA, McNeice GM, Amstutz HC. ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

    PubMed  Google Scholar 

  14. Gunderson C, D’Ambrosia RD, Shoji H. Total hip replacement in patients with sickle cell disease. J Bone Joint Surg Am. 1977;59:760–762.

    PubMed  CAS  Google Scholar 

  15. Hammer M, Geier KA, Aksoy S, Reynolds HM. Perioperative care for patients with sickle cell who are undergoing total hip replacement as treatment for osteonecrosis. Orthop Nurs. 2003;22:384–397.

    Article  PubMed  Google Scholar 

  16. Hanker GJ, Amstutz HC. Osteonecrosis of the hip in sickle cell disease. J Bone Joint Surg Am. 1988;70:499–506.

    PubMed  CAS  Google Scholar 

  17. Hartley WT, McAuley JP, Culpepper WJ, Engh CA Jr, Engh Sr CA. Osteonecrosis of the femoral head treated with cementless total hip arthroplasty. J Bone Joint Surg Am. 2000;82:1408–1413.

    PubMed  Google Scholar 

  18. Hernigou P, Bachir D, Galacteros F. Avascular necrosis of the femoral head in sickle cell disease. Treatment of collapse by injection of acrylic cement. J Bone Joint Surg Br. 1993;75:875–880.

    PubMed  CAS  Google Scholar 

  19. Hernigou P, Bachir D, Galacteros F. The natural history of symptomatic osteonecrosis in adults with sickle cell disease. J Bone Joint Surg Am. 2003;85:500–504.

    Article  PubMed  Google Scholar 

  20. Hernigou P, Beaujean F. Autologous bone marrow grafting of avascular osteonecrosis before collapse. J Bone Joint Surg Br. 1997;79(Supplement II):148.

    Google Scholar 

  21. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002;405:14–23.

    Article  PubMed  Google Scholar 

  22. Hernigou P, Bernaudin F, Reinert P, Kuentz M, Vernant JP. Bone marrow transplantation in sickle cell disease; effect on osteonecrosis. J Bone Joint Surg Am. 1997;79:1726–1730.

    Article  PubMed  CAS  Google Scholar 

  23. Hernigou P, Galacteros F, Bachir D, Goutallier D. Deformities of the hip in adults who have sickle-cell disease and had avascular necrosis in childhood. J Bone Joint Surg Am. 1991;73:81–92.

    PubMed  CAS  Google Scholar 

  24. Hernigou P, Habibi A, Bachir D, Galacteros F. The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease J Bone Joint Surg Am. 2006;88:2565–2572.

    Article  PubMed  Google Scholar 

  25. Hickman JM, Lachiewicz PF. Results and complications of total hip arthroplasties in patients with sickle-cell hemoglobinopathies. Role of cementless components. J Arthroplasty. 1997;12:420–425.

    Article  PubMed  CAS  Google Scholar 

  26. Hodgkinson JP, Shelley P, Wroblewski BM. The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. Clin Orthop Relat Res. 1988;228:105–109.

    PubMed  Google Scholar 

  27. Ilyas I, Moreau P. Simultaneous bilateral total hip arthroplasty in sickle cell disease. J Arthroplasty. 2002;17:441–445.

    Article  PubMed  CAS  Google Scholar 

  28. Langlais F, Kerboull M, Sedel L, Ling RSM. The ‘French paradox.’ J Bone Joint Surg Br. 2003;85:17–20.

    Article  PubMed  CAS  Google Scholar 

  29. Lifeso R. Total joint replacement in sickle cell disease. Orthop Trans. 1985;9:453.

    Google Scholar 

  30. Loudon JR, Charnley J. Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br. 1980;62:450–453.

    PubMed  Google Scholar 

  31. Loudon JR, Older MWJ. Subsidence of the femoral component related to long-term outcome of hip replacement. J Bone Joint Surg Br. 1989;71:624–628.

    PubMed  CAS  Google Scholar 

  32. Merle d’Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.

    Google Scholar 

  33. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–474.

    PubMed  CAS  Google Scholar 

  34. Moran MC, Huo MH, Garvin KL, Pellicci PM, Salvati EA. Total hip arthroplasty in sickle cell hemoglobinopathy. Clin Orthop Relat Res. 1993;294:140–148.

    PubMed  Google Scholar 

  35. Mukisi-Mukaza M, Elbaz A, Samuel-Leborgne Y, Kéclard L, Le Turdu-Chicot C, Christophe-Duchange E, Mérault G. Prevalence, clinical features, and risk factors of osteonecrosis of the femoral head among adults with sickle cell disease. Orthopedics. 2000;23:357–363.

    PubMed  CAS  Google Scholar 

  36. Neumayr L, Aguilar C, Earles P, Jergesen H, Haberkern C, Kammen B, Nancarrow P, Padua E, Milet M, Stulberg B, Williams R, Orringer E, Graber N, Robertson S, Vichinsky E. The National Osteonecrosis Trial in Sickle Cell Anemia Study Group. Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease: results of a multicenter study at a mean of three years after treatment. J Bone Joint Surg Am. 2006;88:2573–2582.

    Article  PubMed  Google Scholar 

  37. Pellegrini VD Jr, Clement D, Lush-Ehmann C, Keller GS, Evarts CM. The John Charnley Award. Natural history of thromboembolic disease after total hip arthroplasty. Clin Orthop Relat Res. 1996;333:27–40.

    Article  PubMed  Google Scholar 

  38. Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med. 1994;330:1639–1644.

    Article  PubMed  CAS  Google Scholar 

  39. Sathappan S, Ginat D, Di Cesare P. Multidisciplinary management of orthopaedic patients with sickle cell disease. Orthopedics. 2006;29:1094–1101.

    PubMed  Google Scholar 

  40. Setty BN, Kulkami S, Rao AK, Stuart MJ. Fetal hemoglobin in sickle cell disease: relationship to erythrocyte phosphatidylserine exposure and coagulation activation. Blood. 2000;96:1119–1124.

    PubMed  CAS  Google Scholar 

  41. Steinberg ME, Hayen GD, Steinberg D. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77:34–41.

    PubMed  CAS  Google Scholar 

  42. Steinberg MH. Management of sickle cell disease. N Engl J Med. 1999;340:1021–1030.

    Article  PubMed  CAS  Google Scholar 

  43. Stuart MJ, Nagel RL. Sickle-cell disease. Lancet. 2004;364:1343–1360.

    Article  PubMed  Google Scholar 

  44. Styles LA, Vichinsky EP. Core decompression in avascular necrosis of the hip in sickle cell disease. Am J Hematol. 1996;52:103–107.

    Article  PubMed  CAS  Google Scholar 

  45. Vichinsky EP, Haberkern CM, Neumayr L, Earles AN, Black D, Koshy M, Pegelow C, Abboud M, Ohene-Frempong K, Iyer RV. A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. The Preoperative Transfusion in Sickle Cell Disease Study Group. N Engl J Med. 1995;333:206–213.

    Article  PubMed  CAS  Google Scholar 

  46. Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med. 2000;342:1855–1865.

    Article  PubMed  CAS  Google Scholar 

  47. Vichinsky EP, Neumayr LD, Haberkern C, Earles AN, Eckman J, Koshy M, Black DM. The perioperative complication rate of orthopedic surgery in sickle cell disease: report of the National Sickle Cell Surgery Study Group. Am J Hematol. 1999;62:129–138.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Dr. Dora Bachir and Dr. Anoosha Habibi for advice concerning the transfusion treatment.

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Authors and Affiliations

  1. Chirurgie Orthopedique et Traumatologique, Hôpital Henri Mondor, University Paris XII, 51 Avenue de Lattre de Tassigny, 94010, Creteil, APHP, France

    Philippe Hernigou MD, Sebastien Zilber MD, Paolo Filippini MD, Gilles Mathieu MD, Alexandre Poignard MD & Frederic Galacteros MD

Authors
  1. Philippe Hernigou MD
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  2. Sebastien Zilber MD
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  3. Paolo Filippini MD
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  4. Gilles Mathieu MD
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  5. Alexandre Poignard MD
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  6. Frederic Galacteros MD
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Correspondence to Philippe Hernigou MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

The corresponding author confirms four authors were required to design the study and all authors participated in a material way in at least three elements of the study and report.

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Hernigou, P., Zilber, S., Filippini, P. et al. Total THA in Adult Osteonecrosis Related to Sickle Cell Disease. Clin Orthop Relat Res 466, 300–308 (2008). https://doi.org/10.1007/s11999-007-0069-3

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  • DOI: https://doi.org/10.1007/s11999-007-0069-3

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