Postoperative Complications and Cost Implications in Sickle Cell Disease Patients Undergoing Total Hip Arthroplasty: A National Inpatient Sample Study

Overview

Journal J Orthop

Specialty Orthopedics

Date 2024 Dec 18

PMID 39691649

Authors

Michael Miskiewicz

Rafael Madera

Ilan Pesselev

James Gallagher

David Komatsu

James Nicholson

Affiliations

Soon will be listed here.

Abstract

Background: Sickle cell disease (SCD) is a genetic condition affecting approximately 5 % of the global population, with significant prevalence in sub-Saharan Africa and an estimated 89,079 cases in the United States. Osteonecrosis, particularly of the femoral head (ONFH), is a common orthopaedic complication in SCD, often requiring total hip arthroplasty (THA) when conservative treatments fail. While THA can improve pain and function, it carries significant perioperative risks, with complication rates in patients with SCD as high as 67 %. This study aims to compare postoperative outcomes, medical costs, and the impact of different THA implant designs in patients with SCD versus a matched non-SCD cohort.

Methods: The study utilized the National Inpatient Sample (NIS) database. Postoperative outcomes in patients with and without SCD undergoing total hip arthroplasty between the fourth quarter of 2015 and 2020 were analyzed using propensity score matching and multivariable logistic regression modeling. Additionally, a subgroup analysis examined outcomes based on the use of cemented versus non-cemented implants.

Results: The study analyzed 2,830,040 hip arthroplasty patients, including 2535 with sickle cell disease (SCD), and after propensity score matching, found that patients with SCD had significantly higher rates of postoperative complications such as periprosthetic fractures, dislocations, infections, and acute kidney injury. Multivariate analysis confirmed SCD as an independent risk factor for these complications, along with increased hospital stays and higher charges. Additionally, patients with SCD receiving cemented implants experienced worse outcomes, including higher risks of periprosthetic fractures and infections, compared to those with non-cemented implants.

Conclusion: This study found that patients with sickle cell disease (SCD) undergoing total hip arthroplasty had significantly higher complication rates, increased healthcare costs, and longer hospital stays, with cemented implants posing greater risks compared to press-fit implants.

References

Cusano J, Curry E, Kingston K, Klings E, Li X . Epidemiology and Perioperative Complications in Patients With Sickle Cell Disease After Orthopaedic Surgery: 26 Years' Experience at a Major Academic Center. J Am Acad Orthop Surg. 2019; 27(23):e1043-e1051. DOI: 10.5435/JAAOS-D-18-00288. View

Meissner N, Halder A, Schrednitzki D . Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study. Arch Orthop Trauma Surg. 2023; 143(10):6447-6451. PMC: 10088768. DOI: 10.1007/s00402-023-04851-9. View

Kamath A, McGraw M, Israelite C . Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease. World J Orthop. 2015; 6(10):776-82. PMC: 4644865. DOI: 10.5312/wjo.v6.i10.776. View

Acuna A, Do M, Samuel L, Grits D, Otero J, Kamath A . Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures. Arch Orthop Trauma Surg. 2021; 142(10):2965-2977. DOI: 10.1007/s00402-021-04186-3. View

Naseer Z, Bachabi M, Jones L, Sterling R, Khanuja H . Osteonecrosis in Sickle Cell Disease. South Med J. 2016; 109(9):525-30. DOI: 10.14423/SMJ.0000000000000516. View

Adesina O, Neumayr L . Osteonecrosis in sickle cell disease: an update on risk factors, diagnosis, and management. Hematology Am Soc Hematol Educ Program. 2019; 2019(1):351-358. PMC: 6913430. DOI: 10.1182/hematology.2019000038. View

Al-Otaibi M . An overview of pathophysiology and treatment options of osteonecrosis of femoral head in sickle cell disease. Saudi Med J. 2022; 43(11):1192-1199. PMC: 10043914. DOI: 10.15537/smj.2022.43.11.20220429. View

Rees D, Williams T, Gladwin M . Sickle-cell disease. Lancet. 2010; 376(9757):2018-31. DOI: 10.1016/S0140-6736(10)61029-X. View

Hyder O, Yaster M, Bateman B, Firth P . Surgical procedures and outcomes among children with sickle cell disease. Anesth Analg. 2013; 117(5):1192-6. DOI: 10.1213/ANE.0b013e3182a44d74. View

10.

Farook M, Awogbade M, Somasundaram K, Reichert I, Li P . Total hip arthroplasty in osteonecrosis secondary to sickle cell disease. Int Orthop. 2018; 43(2):293-298. PMC: 6399197. DOI: 10.1007/s00264-018-4001-0. View

11.

Perfetti D, Boylan M, Naziri Q, Khanuja H, Urban W . Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A nationwide database study. J Arthroplasty. 2014; 30(4):547-51. DOI: 10.1016/j.arth.2014.10.035. View

12.

Almarzooq O, Alhassan M, Alansari L, Alanazi T, Madan F . Cemented Versus Uncemented Total Hip Arthroplasty in Sickle Cell Disease Patients: A Retrospective Study. Cureus. 2023; 15(3):e36138. PMC: 10101182. DOI: 10.7759/cureus.36138. View

13.

Gu A, Agarwal A, Fassihi S, Pollard T, Stoll W, Campbell J . Impact of sickle cell disease on postoperative outcomes following total hip arthroplasty. Hip Int. 2021; 33(3):391-396. DOI: 10.1177/11207000211052224. View

14.

Hall B, Reiter A, Englum B, Rothman J, Rice H . LONG-TERM HEMATOLOGIC AND CLINICAL OUTCOMES OF SPLENECTOMY IN CHILDREN WITH HEREDITARY SPHEROCYTOSIS AND SICKLE CELL DISEASE. Pediatr Blood Cancer. 2023; 67(8). PMC: 10151035. DOI: 10.1002/pbc.28290. View

15.

Al-Otaibi M, Waliullah S, Kumar V . Total Hip Replacement in Sickle Cell Disease Patients with Avascular Necrosis of Head of Femur: A Retrospective Observational Study. Indian J Orthop. 2021; 55(5):1225-1231. PMC: 8586121. DOI: 10.1007/s43465-021-00394-6. View

16.

Fassihi S, Lee R, Quan T, Tran A, Stake S, Unger A . Total Hip Arthroplasty in Patients With Sickle Cell Disease: A Comprehensive Systematic Review. J Arthroplasty. 2020; 35(8):2286-2295. DOI: 10.1016/j.arth.2020.04.014. View

17.

Quan H, Li B, Couris C, Fushimi K, Graham P, Hider P . Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676-82. DOI: 10.1093/aje/kwq433. View

18.

Kenanidis E, Kapriniotis K, Anagnostis P, Potoupnis M, Christofilopoulos P, Tsiridis E . Total hip arthroplasty in sickle cell disease: a systematic review. EFORT Open Rev. 2020; 5(3):180-188. PMC: 7144887. DOI: 10.1302/2058-5241.5.190038. View

19.

Sundd P, Gladwin M, Novelli E . Pathophysiology of Sickle Cell Disease. Annu Rev Pathol. 2018; 14:263-292. PMC: 7053558. DOI: 10.1146/annurev-pathmechdis-012418-012838. View

20.

Levesque E, Lim C, Feray C, Salloum C, Quere A, Robin B . Liver transplantation in patients with sickle cell disease: possible but challenging-a cohort study. Transpl Int. 2020; 33(10):1220-1229. DOI: 10.1111/tri.13669. View