Bipolar hip replacement in sickle cell disease.

A retrospective study is presented of 26 uncemented bipolar hip replacements for avascular necrosis of the femoral head due to sickle cell disease which were carried out between 1987 and 1992. All patients were treated according to a protocol. The average follow up was 4.6 years (range 2.1 to 7 years). After operation, the average Harris hip score improved from 36 to 88. Bone culture was positive for bacterial growth in 4 hips (coagulase negative staphylococcus in 3). There was progressive wear of acetabular articular cartilage in 2 cases, but no clinical or radiological evidence of loosening of the femoral stem. Seventeen complications occurred in 9 of the 21 patients (5 in one patient). A longitudinal split of the femur was the commonest operative complication and occurred in 5 hips. Femoral medullary sclerosis was seen in 8 cases. Patients with sickle cell disease have a high risk of complications, but this type of hip replacement should be considered in carefully selected patients who have avascular necrosis of the femoral head.