Hip

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Hip

  1. 1. Sickle Cell Disease &Total Hip Arthroplasty
  2. 2. The three principle orthopaedic manifestations• pyogenic infections• marrow hyperplasia• osteonecrosis J Am Acad Orthop Surg 2005;13:208-217
  3. 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. 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. 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. 6. Patient Evaluation and Natural History• Groin pain• limited ROM• Often bilateral
  7. 7. Nonsurgical Management• pain management• assistive devices• typically progresses J Bone Joint Surg Am 2003;85:500-504
  8. 8. Surgical Management• disabling hip pain• severely damaged hip joint• Medically fit
  9. 9. Surgical Management• THA• Core decompression• Femoral osteotomy• Arthrodesis• Hemiarthroplasty• Resection arthroplasty
  10. 10. • No Level 1 or 2 evidence• Steinberg stages I and II J Am Acad Orthop Surg 2005;13:208-217
  11. 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. 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. 13. Preoperative Considerations• hemoglobin S level < 30% Am J Hematol. 1999 Nov;62(3):129-38
  14. 14. Intraoperative Considerations• wide medullary canal an thin cortices• sclerosis, and canal obliteration
  15. 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. 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. 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. 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. 19. Surgical Complications• Hip Dislocation (26%) J Arthroplasty 1997;12:420-425

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