Hernigou Philippe, Homma Yasuhiro, Bastard Claire, Yoon Byoung-Chol, Lachaniette Charles-Henri Flouzat
Paris-Est Créteil University, Créteil, France.
Juntendo University Hospital, Tokyo, Japan.
Int Orthop. 2025 Feb;49(2):407-419. doi: 10.1007/s00264-024-06394-z. Epub 2024 Dec 21.
Hip deformity is frequent after childhood osteonecrosis in patients with sickle cell disease (SCD). When they are adults, they present a challenge as candidates for total hip arthroplasty (THA) because of abnormal bone development, their relative youth, and also because of their disease. Performing subtrochanteric osteotomy associated with THA is technically challenging, and healing of osteotomies has never been reported in this population with frequent osteonecrotic bone, whether using cemented or uncemented arthroplasties.
We retrospectively analyzed 59 cemented THA with femoral corrective osteotomies (subtrochanteric shortening and transverse derotational osteotomy) performed on hip deformities between 1984 and 2018 in 59 sickle cell adult patients. The patient's age at the onset of osteonecrosis was an average of 8.4 years (6 to 10 years), and at the time of the THA was 28.6 years (19 to 41 years). All the patients had a minimum followup period of six years. Endocrinopathy was frequently associated to SCD Data and consequences were evaluated on bone union. The mechanical variables, such as the length of the resected femur, limb lengthening, the location of the osteotomy site, the size of the stem bridging the osteotomy, and any complications, were also analyzed.
The average length of the resected femoral segment was 38.4 mm. The length of the femoral stem (bridging the osteotomy) was average 13 cm. The mean osteotomy union time was 10.6 months. Twenty-four osteotomies healed in six months, six in nine months, and 29 in twelve months, while five required bone grafts at nine months. The union time of the osteotomy was average 10.6 months. Complications included four cases of transient nerve palsy, and five intraoperative femur perforations. No statistically significant relationship was found between osteotomy union time and mechanical variables. The severity of endocrinopathy associated with sickle cell disease prolonged the healing time. In three cases, cement leakage into the osteotomy gap occurred without resulting in non-healing.
Cemented THA, combined with a subtrochanteric femoral shortening with transverse derotational osteotomy, has a long union time but is effective for adult hip deformities of patients with sickle cell patients.
镰状细胞病（SCD）患者儿童期骨坏死之后髋关节畸形很常见。成年后，由于骨骼发育异常、相对年轻以及自身疾病，他们作为全髋关节置换术（THA）的候选者面临挑战。实施与THA相关的转子下截骨术在技术上具有挑战性，而且在这个骨坏死频繁的人群中，无论使用骨水泥型还是非骨水泥型关节置换术，截骨愈合情况此前从未有过报道。
我们回顾性分析了1984年至2018年间对59例成年镰状细胞病患者因髋关节畸形实施的59例骨水泥型THA及股骨矫正截骨术（转子下缩短和横向旋转截骨术）。骨坏死发病时患者的平均年龄为8.4岁（6至10岁），THA时的平均年龄为28.6岁（19至41岁）。所有患者的最短随访期为6年。内分泌病常与SCD相关，评估其数据及对骨愈合的影响。还分析了机械变量，如切除的股骨长度、肢体延长情况、截骨部位、跨越截骨处的假体柄尺寸以及任何并发症。
切除的股骨段平均长度为38.4毫米。股骨柄（跨越截骨处）的平均长度为13厘米。截骨平均愈合时间为10.6个月。24例截骨在6个月愈合，6例在9个月愈合，29例在12个月愈合，5例在9个月时需要植骨。截骨愈合时间平均为10.6个月。并发症包括4例短暂性神经麻痹和5例术中股骨穿孔。未发现截骨愈合时间与机械变量之间存在统计学上的显著关系。与镰状细胞病相关的内分泌病严重程度延长了愈合时间。3例出现骨水泥渗漏至截骨间隙，但未导致不愈合。
骨水泥型THA联合转子下股骨缩短及横向旋转截骨术愈合时间长，但对成年镰状细胞病患者的髋关节畸形有效。
