Quality of life in sickle cell patients after Cementless Total Hip Replacement

Abstract Background Osteonecrosis of femoral head is a serious relentlessly progressive and disabling complications in 20-50% of sickle cell patients, majority of whom are in their second to third decades. High perioperative medical complications and short survivorship has historically discouraged arthroplasty surgeons in offering total hip arthroplasty to sickle cell patients in their 30’s for the fear of inevitable technically demanding revision. In this retrospective study the primary objective is to assess the impact of early intervention on quality of life at mid-term follow up of mean 7.5 years using noncemented porous coated total hip replacement. The secondary objective of the study is the survival of the prostheses within the same follow-up period and discussion of surgical challenges faced in this cohort of patients. Material & Methods 67 (84 hip replacement) sickle cell patients with advance osteonecrosis of femoral head who underwent cementless porous coated proximal fixation are included in this study. Modified Haris hip score, visual analogue scale and Quality of life (QOL) assessment criteria are used to assess the outcome. Result Revision surgery was required in seven patients for aseptic loosening and in one patient due to late infection. Visual analogue scale (VAS) improved from average 7 (6-9) to 3 (2-5). Mean Harris hip score improved from 46 (32- 58) to 81 (74- 86). Quality of life score rose from a mean of 3 (range 1-4) to 7 (range 6- 9). In terms of gender, survival in males was 94.30 %, while in females it was 88.767%. Revision surgery was required in seven patients due to aseptic loosening and one patient due to late infection at 7 year. Discussion and Conclusion We recommend early hip replacement in sickle cell patients, if the hip has reached a stage of irreversible damage and patient’s life style is severely compromised in order to minimize chronic suffering and disability.