Abstract
Osteonecrosis of femoral head is a serious relentlessly progressive and disabling complication in 20%-50% of sickle cell patients, majority of whom are in their second to third decades. High perioperative medical complications and short survivorship have historically discouraged arthroplasty surgeons in offering total hip arthroplasty to sickle cell patients in their 30s for the fear of inevitable technically demanding revision. In this retrospective study, the primary objective was to assess the impact of early intervention on quality of life (QOL) at midterm follow-up of mean 7.5 years using uncemented porous-coated total hip arthroplasty. The secondary objective of this study was the survival of the prostheses within the same follow-up period and discussion of surgical challenges faced in this cohort of patients.
A total of 67 (84 hip arthroplasties) sickle cell patients with advance osteonecrosis of femoral head who underwent cementless porous-coated proximal fixation are included in this study. Modified Harris Hip Score, visual analog scale, and QOL assessment criteria are used to assess the outcome.
Revision surgery was required in 7 patients for aseptic loosening and in 1 patient due to late infection. Visual analog scale improved from average 7 (6-9) to 3 (2-5). Mean Harris Hip Score improved from 46 (32-58) to 81 (74-86). QOL score rose from a mean of 3 (range 1-4) to 7 (range 6-9). In terms of gender, survival in males was 94.30%, whereas in females, it was 88.767%. Revision surgery was required in 7 patients due to aseptic loosening and in 1 patient due to late infection at 7 years.
We recommend early hip arthroplasty in sickle cell patients, if the hip has reached a stage of irreversible damage and patient's lifestyle is severely compromised to minimize chronic suffering and disability.