Total hip arthroplasty after avascular necrosis due to sickle cell disease in Senegal: Series of 48 prosthesis

The purpose of this study is to describe the outcome of total hip arthroplasty for management of aseptic osteonecrosis of the femoral head due to sickle cell disease. This consecutive series carried out over a 7-year period in 38 patients with a sickle-cell anaemia includes a total of 48 cemented prosthesis. The mean follow-up period was 5 years. Arthroplasty restored normal hip function (PMA score = 18) in 64% of cases. In 32% of cases the PMA score was more than 15. Pain was greatly reduced with total relief being achieved in 94% of cases. Walking ability also improved with 85% of patients having an unlimited walking distance. Radiological examination demonstrated edging on 36% of cupulas and 29% of the shafts. Complications were observed in 19% of cases. The main complications were loosening and dislocation of the prosthesis. Although the complication rate was high, functional outcomes in this series were good. These findings indicate that arthroplasty should be considered as the treatment of choice for aseptic osteonecrosis due to stage 3 and 4 sickle-cell disease in young patients. Use of uncemented implant and type of frictional torque are discussed.