Abstract

BackgroundImmune thrombocytopenia (ITP) is an immune-mediated acquired disease that is characterized by a decrease in the platelet count and an increased risk of bleeding. There is little information in the literature about the results of major joint replacement surgery in patients with ITP. The aim of this study was to report on the results of total hip arthroplasty (THA) in patients with primary ITP.MethodsWe retrospectively identified 15 THAs performed in 11 patients with primary ITP. The study group was matched (1:2) to a non-ITP control group of 30 THAs in 22 patients. According to the perioperative hematologic evaluation, blood management interventions were performed. All procedures were performed by a single surgeon and all patients received cementless components with ceramic-on-ceramic bearing. Mean duration of follow-up was 7.1 years (range, 2–13).ResultsNo significant differences were found between the two groups with regard to mean operative time, intraoperative blood loss, amount of closed suction drainage, length of hospital stay, and readmission rate. However, the proportion of patients requiring transfusion of packed red blood cells and/or platelet concentrate was higher in the ITP group when compared to the non-ITP group. Mean Harris hip score improved from 49.5 points preoperatively to 93.4 points at the final follow-up and no hips were revised for loosening or osteolysis in the ITP group. No significant differences were found between the two groups with respect to mean postoperative Harris hip scores and complication rates.ConclusionsOur study showed encouraging clinical and radiographic results of THA in patients with ITP without increased risk of adverse events compared to those in patients without ITP. On the basis of these findings, we suggest that modern cementless THA might be a viable treatment for achieving functional improvement in patients with ITP and end-stage hip disease.

Highlights

  • Immune thrombocytopenia (ITP) is an immune-mediated acquired disease that is characterized by a decrease in the platelet count and an increased risk of bleeding

  • The primary aim of this study was to report on the clinical and radiographic outcomes of total hip arthroplasty (THA) in patients with primary ITP, and the secondary aim was to determine whether patients with and without ITP differ with respect to early postoperative outcomes, Harris hip scores, and radiographic results

  • We retrospectively reviewed the medical records of 11 consecutive patients with primary ITP who underwent 15 cementless THAs between 2001 and 2011 at our institution

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Summary

Introduction

Immune thrombocytopenia (ITP) is an immune-mediated acquired disease that is characterized by a decrease in the platelet count and an increased risk of bleeding. There is little information in the literature about the results of major joint replacement surgery in patients with ITP. Immune thrombocytopenia (ITP) is an immunemediated acquired disease characterized by a transient or persistent decrease in platelet count and an increased risk of bleeding [1,2,3]. Little information is available in the literature concerning the results of major joint replacement surgery in patients with ITP, being limited to isolated English and non-English language case reports [8,9,10]. Questions remain as to whether patients with ITP can safely undergo THA, as these patients may be at increased risk of surgical complications and mortality [7, 11]

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