Total hip arthroplasty in sickle cell disease: A systematic review and meta-analysis of functional outcomes and complications.

BACKGROUND

Sickle cell disease (SCD) is a significant risk factor for avascular necrosis (AVN) of the femoral head, often necessitating total hip arthroplasty (THA) at a younger age than patients with primary osteoarthritis. This systematic review and meta-analysis aimed to evaluate the functional outcomes, surgical complications, and intraoperative blood loss in SCD patients undergoing THA.

MATERIALS AND METHODS

A systematic search of databases, including Cochrane, Web of Science, Scopus, EMBASE, and PubMed, was conducted on November 5, 2024. Studies involving sickle cell patients who underwent THA were included. Functional outcomes were assessed using scoring systems such as the Oxford Hip Score (OHS) and Harris Hip Score (HHS). Postoperative complications, revision rates, and intraoperative blood loss were also analyzed. Statistical analyses were conducted to derive pooled estimates and confidence intervals. PROSPERO ID: CRD42024609360.

RESULTS

A total of 25 studies met the inclusion criteria, comprising both retrospective and prospective studies. The pooled analysis revealed a significant improvement in functional outcomes, with a mean HHS increase of 6.96 (95 % CI: 5.56-8.35). Mean age of patients ranged from 20 to 35 years. Pooled estimate of complications included aseptic loosening (12 %), dislocation (1 %), heterotopic ossification (8 %), iatrogenic fracture (8 %), infection (8 %), osteolysis (8 %), periprosthetic fractures (8 %), revision surgery (11 %), sickle cell crisis (5 %), and thromboembolism (2 %). The mean blood loss was 1059.24 ml.

CONCLUSION

THA in sickle cell patients presents considerable challenges with a high risk of complications. Despite these challenges, THA can lead to functional improvement. Given the heightened risk profile, multidisciplinary perioperative care strategies are essential to optimize outcomes.