Post on 31-Mar-2015
transcript
TOTAL HIP ARTHROPLASTY IN ADULT PATIENTS WITH SICKLE CELL DISEASE
(1983-2005)
P. Hernigou Hospital Henri Mondor 94000 Créteil
336 hips(M=15/year since 22 years)
SICKLE CELL DISEASE
SICKLE CELL DISEASE
Total hip replacement in such patients who are less than forty years old has been associated with high rates of complications and revisions. Also, the majority of such patients with sickle cell disease have been reported to have a high prevalence of failure of components fixation
The purpose of the present study was to analyze the results after primary total hip arthroplasty with cement in a group of patients who had sickle cell disease
• anatomic abnormalities
• infection of the hip during childhood
• Transfusions and anemia
• Allo immunisation
• Pulmonary Infarctus
• Revisions
Problems
The anatomic abnormalities
» The anatomic abnormalities may include »abnormal location of neurovascular structures
secondary to soft-tissue contractures, »an abnormal location of the hip center,»a limb-length discrepancy,» a small acetabulum and femoral canal» increased anteversion of the proximal part of the
femur.
Medullary osteonecrosis
Risk Factors of Intraoperative perforation of the femur
Levels of Deformity Femoral Neck Deformity
Greater Trochanteric Deformity
Levels of Deformity Metaphyseal Deformity
as a result of an osteotomy.
Diaphyseal Deformity
OSTEOTOMIES
20 ans
dysplastic acetabulum
dysplastic acetabulum
dysplastic acetabulum
Coxa profonda
• anatomic abnormalities
• infection of the hip during childhood
• Transfusions and anemia
• Allo immunisation
• Pulmonary Infarctus
• Revisions
Problems
10 hips in patients who had had infection of the hip during childhood
All the hips had cemented total hip replacements. The age of the patients at the time that the infection was contracted was an average of 12 years).
The average age of the patients at the time of the total hip arthroplasty was 32.4 years. The interval between active infection and arthroplasty was 24 years. All the hips had a quiescent period of infection of more than ten years. The average duration of follow-up was 8 years (range, five to fifteen years).
Two hips had recurrence of infection.
infections
inégalité
Fémur anormal
• anatomic abnormalities
• infection of the hip during childhood
• Transfusions and anemia
• Allo immunisation
• Pulmonary Infarctus
• Revisions
Problems
Transfusions:risk of allo-immunisation
pulmonary Infarctus
• anatomic abnormalities
• infection of the hip during childhood
• Transfusions and anemia
• Allo immunisation
• Pulmonary Infarctus
• Revisions
Problems
Results:336 hips
average follow-up: 10 years(10 to 20)
60 THA >10 years
Surgery at 18 years oldfollowup: 22 years
Followup: 22 years
Followup: 22 years
336 protheses
22 revisions
Infections 3
1 revision 7
2 revisions 2
3 revisions 1
4 revisions 3
Revisions: 6 %
Risk of iterative revisions
Conclusion• The management of hip arthroplasty with
sickle cell disease requires recognition of anatomical deformities
• Assessment begins in the preoperative period with recognition of significant risk factors, including previous surgery systemic medical conditions, as well as selection of suitable components.