Traitement des arthrites septiques de hanche chez l’adulte drépanocytaire par prothèse totale de hanche

Perioperative management for orthopaedic patients with sickle cell anaemia

PURPOSE

To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries.

METHODS

12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared.

RESULTS

No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen.

CONCLUSION

Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.

Alumina-on-alumina hip arthroplasty in patients younger than 30 years old

THA in patients younger than 30 years old presents challenges: the initial technical challenge relates to the initial disease that often causes deformities making reconstruction difficult, while the long-term challenge is wear and subsequent osteolysis and component loosening. Ceramic-on-ceramic prostheses may represent a valuable option to reduce wear. We retrospectively studied 101 patients (132 hips) with ceramic-on-ceramic prostheses implanted from 1977 to 2004. As a result of the long span of time, different implant designs and modes of fixation were used. The average age of the patients was 23.4+/-5 years (range, 13-30 years), and the main indication for THA was femoral head necrosis. The minimum followup was 1 year (mean, 6.9 years; range, 1-26.5 years). We documented 17 revisions (13%) for aseptic loosening. Twelve were for isolated acetabular loosening, two for isolated femoral loosening, and three for loosening of both components. Survivorship was 82.1% at 10 years and 72.4% at 15 years. Inferior survivorship was observed for THA performed after secondary arthritis related to slipped capital epiphysis or trauma. Limited osteolysis was observed in one hip. The main limiting factor in this series was the fixation of the acetabular component. However, improvements in the design and in the mode of fixation of this component should enhance long-term results.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.