Mohammad K. AlsaleemKing Fahad Hospital Hofuf, KSA
Title: Intraoperative Periprosthetic Fractures in Total Hip Arthroplasty in Patients With Sickle Cell Disease at King Fahad Hospital Hofuf: A Cross- Sectional Study
Aim of the study
This cross-sectional retrospective study aimed to assess the prevalence and associated risk factors for periprosthetic fractures during total hip arthroplasty in sickle cell disease patients at King Fahad Hospital Hofuf, Saudi Arabia.
We collected the data of all SCD patients who had undergone THA during the study period, January 2015 to September 2020. Forty-nine SCD patients who had undergone THA during the study period were included. Patients who had undergone hip hemiarthroplasty, postoperative fractures, or had an indication of THA other than avascular necrosis were excluded. Surgeon factors, assistant factors, and surgical technique were also excluded. We then analyzed the data according to gender, age, BMI, American Society of Anesthesiologists classification, implant fixation type, avascular necrosis stage, proximal femoral morphology, Vancouver classification type, sickle cell type, preoperative hemoglobin (Hb) level, and the risk of periprosthetic fractures. Descriptive statistics were presented using frequency and percentages for categorical variables, and continuous variables were summarized using means ± standard deviations. Independent t-tests and chi-square tests were used to test for associations between categorical variables. At 0.05, the significance level was set.
Of the patients, 32.7% were male and 67.3% were female. 32.7% of the patients had advanced degenerative changes due to avascular necrosis. Among the patients, 20.4% had an intraoperative periprosthetic femoral fracture, 90% had a Vancouver classification class A, and 10% had a Vancouver classification class B1. According to Dorr classification, 75.5% were classified as Dorr A and 24.5% as Dorr B. Of the patients, 48 had an uncemented implant, and only 1 had cemented. The mean perioperative Hb was 9.02 + 2.02, with a minimum of 6 and a maximum of 14. No significant associations were found between the incidence of intraoperative femoral fracture and the demographic variables and the operative profile characteristics. However, a significantly higher rate of fracture was observed in patients operated on the right side compared to patients operated on the left side.
The prevalence of periprosthetic intraoperative fracture among SCD patients at King Fahad Hospital Hofuf was 20.4% during the study period. Even with adequate perioperative management, orthopedic surgeons must be prepared to deal with high rates of intraoperative fracture. No significant association was found between the incidence of intraoperative femoral fracture in SCD patients and the demographic variables and the operative profiles. However, a significantly higher rate of fracture was observed in patients operated on the right side compared to patients operated on the left side.