Multidisciplinary protocol for the treatment of patients with sickle cell anemia undergoing total hip arthroplasty. Experience in a hospital in Cali, Colombia
DOI:
https://doi.org/10.58814/01208845.97Keywords:
Total Hip Replacement, Sickle Cell Anemia, Femoral Head Avascular Necrosis, Clinical ProtocolsAbstract
Introduction: Patients with avascular necrosis of the femoral head (AVN) secondary to sickle cell disease (SCD) are at higher risk of perioperative complications than the general population when undergoing hip arthroplasty.
Objectives: To describe the outcomes of a multidisciplinary protocol for the treatment of patients with SCD undergoing total hip arthroplasty (THA) due to AVN, and to characterize patients who were treated using this protocol at Clínica Imbanaco, a quaternary care hospital in Cali (Colombia).
Methodology: Retrospective descriptive cohort study conducted with data from 12 patients with SCD and AVN taken to THA at the institution between January 2001 and April 2022. Data were collected by reviewing medical records, and the protocol is presented by means of flowcharts.
Results: The mean age of the patients was 33.75 years, 75% (n=9) were female, and THA was performed on the right side in 41.67% (n=5) and bilaterally in 16.66%. The preoperative and postoperative hemoglobin (Hb) mean values were 10.87g/dL (7.7-14.2) and 9.08g/dL (5.7-10.2). Preoperative erythrocytapheresis was performed in 2 patients (Hb-S: 27%-32%). Moreover, 4 patients (33.33%) presented with comorbidities. Mean values for heart rate, respiratory rate, blood pressure, temperature, and oxygen saturation were 77.08bpm, 16.41rpm, 83.1mmHg, 36.53°C, and 96.66, respectively. All patients received postoperative antibiotic prophylaxis and pharmacological thromboprophylaxis, and cementless femoral stems were used in all patients. The mean Oxford scale score was 10.88 preoperatively and 43.11 postoperatively.
Conclusions: According to the results reported here, the multidisciplinary protocol implemented at our institution is effective for the treatment of patients with SCD taken to THA due to AVN.
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