TOTAL HIP ARTHROPLASTY IN ADULT PATIENTS WITH SICKLE CELL DISEASE (1983-2005)

1. TOTAL HIP ARTHROPLASTY IN ADULT PATIENTS WITH SICKLE CELL DISEASE(1983-2005) P. Hernigou Hospital Henri Mondor 94000 Créteil 336 hips(M=15/year since 22 years)

2. SICKLE CELL DISEASE

4. SICKLE CELL DISEASE Total hip replacement in such patients who are less than forty years old has been associated with high rates of complications and revisions. Also, the majority of such patients with sickle cell disease have been reported to have a high prevalence of failure of components fixation The purpose of the present study was to analyze the results after primary total hip arthroplasty with cement in a group of patients who had sickle cell disease

5. Problems • anatomic abnormalities • infection of the hip during childhood • Transfusions and anemia • Allo immunisation • Pulmonary Infarctus • Revisions

6. The anatomic abnormalities • The anatomic abnormalities may include • abnormal location of neurovascular structures secondary to soft-tissue contractures, • an abnormal location of the hip center, • a limb-length discrepancy, • a small acetabulum and femoral canal • increased anteversion of the proximal part of the femur.

7. Medullary osteonecrosis

8. Risk Factors of Intraoperative perforation of the femur

9. Levels of Deformity Femoral Neck Deformity Greater Trochanteric Deformity

10. Levels of Deformity Metaphyseal Deformityas a result of an osteotomy.

11. Diaphyseal Deformity

13. OSTEOTOMIES 20 ans

14. dysplastic acetabulum

15. dysplastic acetabulum

16. dysplastic acetabulum

17. Coxa profonda

19. Problems • anatomic abnormalities • infection of the hip during childhood • Transfusions and anemia • Allo immunisation • Pulmonary Infarctus • Revisions

20. 10 hips in patients who had had infection of the hip during childhood All the hips had cemented total hip replacements. The age of the patients at the time that the infection was contracted was an average of 12 years). The average age of the patients at the time of the total hip arthroplasty was 32.4 years. The interval between active infection and arthroplasty was 24 years. All the hips had a quiescent period of infection of more than ten years. The average duration of follow-up was 8 years (range, five to fifteen years). Two hips had recurrence of infection.

23. infections

24. Fémur anormal inégalité

25. Problems • anatomic abnormalities • infection of the hip during childhood • Transfusions and anemia • Allo immunisation • Pulmonary Infarctus • Revisions

26. Transfusions:risk of allo-immunisation

27. pulmonary Infarctus

28. Problems • anatomic abnormalities • infection of the hip during childhood • Transfusions and anemia • Allo immunisation • Pulmonary Infarctus • Revisions

29. Results:336 hips average follow-up: 10 years(10 to 20) 60 THA >10 years

30. Surgery at 18 years oldfollowup: 22 years

31. Followup: 22 years

32. Followup: 22 years

33. 336 protheses Revisions: 6 % 22 revisions Infections 3 1 revision 7 2 revisions 2 3 revisions 1 4 revisions 3

34. Risk of iterative revisions

35. Conclusion • The management of hip arthroplasty with sickle cell disease requires recognition of anatomical deformities • Assessment begins in the preoperative period with recognition of significant risk factors, including previous surgery systemic medical conditions, as well as selection of suitable components.