Total Hip Arthroplasty for Aseptic Osteonecrosis in Sickle Cell Patients at the Hospital General De Reference De Niamey / Niamey

Abstract

Introduction: Aseptic osteonecrosis of the femoral head is one of the frequent bone sequelae of sickle cell disease. It is difficult and costly to treat. The aim of this study was to determine the complications and evaluate the functional results. Material and methods: This was a retrospective monocentric study including total hip replacements in sickle cell subjects (March 2015 to May 2019), excluding patients with severe comorbidity. The mean follow-up was 12 months. Results: During the study period, 17 patients with sickle cell disease underwent total hip arthroplasty for aseptic osteonecrosis of the femoral head. There were 10 women (58.82%) and 07 men (41.18%). The mean age of the patients, all sexes combined, at the time of surgery was 31 years. The distribution of the hemoglobinopathy phenotype was dominated by the SS homozygous form, accounting for 52.94% of patients. The mean preoperative PMA score was 8.41/18. Radiological classification by Ficat and Arlet showed that 82.35% of hips were stage 4 and 17.65% stage 3. Arthroplasty was performed via a posterolateral Moore approach under spinal anesthesia. Postoperative clinical re-evaluation showed marked improvement, with a mean postoperative PMA score of 17.17/18. Conclusion: The functional and radiological results obtained over time make total hip arthroplasty the treatment of choice for osteonecrosis of the femoral head in sickle cell disease.