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  • 1. Sickle Cell Disease &Total Hip Arthroplasty
  • 2. The three principle orthopaedic manifestations• pyogenic infections• marrow hyperplasia• osteonecrosis J Am Acad Orthop Surg 2005;13:208-217
  • 3. Organisms• Staphylococcus aureus• Streptococcus pneumoniae• Salmonella typhi,• Klebsiella pneumoniae N Engl J Med 1999;340: 1021-1030 Clin Orthop 1993;294:140-148
  • 4. Marrow Hyperplasia• Increased erythropoiesis• widening of the medullary canal and thinning of the trabeculae and cortices, J Bone Joint Surg Br 1989;71: 465-470
  • 5. Osteonecrosis• hypoxia-induced erythrocyte sickling, along with extravascular compression of the intraosseous blood supply caused by medullary hyperplasia• bone or marrow infarction, focal and patchy areas
  • 6. Patient Evaluation and Natural History• Groin pain• limited ROM• Often bilateral
  • 7. Nonsurgical Management• pain management• assistive devices• typically progresses J Bone Joint Surg Am 2003;85:500-504
  • 8. Surgical Management• disabling hip pain• severely damaged hip joint• Medically fit
  • 9. Surgical Management• THA• Core decompression• Femoral osteotomy• Arthrodesis• Hemiarthroplasty• Resection arthroplasty
  • 10. • No Level 1 or 2 evidence• Steinberg stages I and II J Am Acad Orthop Surg 2005;13:208-217
  • 11. • it does not address the primary underlying pathophysiology of vaso-occlusion• femoral head involvement usually is diffuse and too large to decompress• chronic nature of the disease makes future infarcts inevitable despite decompression Am J Orthop 1995;24:18-24
  • 12. Preoperative Considerations• preventing sickle cell crises• paying careful attention to cardiac status and fluid balance• assessing infection• using preoperative transfusion or plasmapheresis• considering anesthetic modalities and pain management technique
  • 13. Preoperative Considerations• hemoglobin S level < 30% Am J Hematol. 1999 Nov;62(3):129-38
  • 14. Intraoperative Considerations• wide medullary canal an thin cortices• sclerosis, and canal obliteration
  • 15. Accetabular Preparation &Component Insertion• Acetabular bone quality may be poor• patches of densely sclerotic bone (eccentric reaming• acetabular protrusio ( medial reaming, Bone Graft, acetabular support and In-situ Osteotomy) J Am Acad Orthop Surg 2005;13:208-217
  • 16. Femoral Canal Preparation• Areas of sclerosis may be so diffuse that the canal becomes completely obliterated• hyperplastic medullary canals, thin cortices• introducing a drill bit under image intensifier until it is possible to insert a guidewire for flexible reamers Int Orthop 2002;26:157-161
  • 17. Medical Complications• excessive bleeding (18%)• pulmonary complications• sickle cell crises• cardiac complications (4%)• mental status changes Am J Hematol 1999;62:129-138
  • 18. Surgical Complications• Infection (25%) • There are no reported cases of Salmonella osteomyelitis complicating a THA; therefore, prophylactic administration of antibiotics that provide coverage for this gram-negative microorganism is not recommended Am J Orthop 1996;25: 353-356 Clin Orthop 1993;294:140-148
  • 19. Surgical Complications• Hip Dislocation (26%) J Arthroplasty 1997;12:420-425