Management strategies for total hip arthroplasty in sickle cell patients.

Sickle cell anemia is an inherited hemoglobinopathy in which there is a structural change to the erythrocyte from round to crescent shaped or sickled. These abnormally shaped cells can block small vessels resulting in compromise of vascular supply, pain, and end-organ damage. These patients are particularly susceptible to hip osteonecrosis, which in late stages may require a total hip arthroplasty. Historically, total hip arthroplasty had inferior outcomes in this patient population due to poorer clinical outcomes and higher perioperative complications. During recent decades, however, there have been some improvements in the medical management of these patients, which has potentially improved the clinical outcomes of this procedure. In this article, we review all reported management strategies for the perioperative care of sickle cell anemia patients undergoing total hip arthroplasty.

Patellar fractures following total knee arthroplasty: a review.

There are several periprosthetic complications associated with total knee arthroplasty, with femoral fracture as the most common and patellar fractures as the second most common. Patellar fractures are challenging complications that occur almost exclusively on the resurfaced patellae, although unresurfaced patellar fractures have been reported in literature. The purpose of this study is to describe the anatomy of the patella, the etiology of patellar fractures, and strategies to treat and manage these fractures following knee arthroplasty. The vascular supply to the patella may be compromised during total knee arthroplasty and special care must be taken to preserve it. Vessel injury may result in further complications, most notably avascular necrosis with subsequent fracture. Other patient-, surgical-, and prosthetic-related factors can contribute to increased risk of patellar fracture. Patellar fractures are classified into three types. Type I fractures have an intact extensor mechanism with a stable implant. Type II fractures have a complete disruption of the extensor mechanism with or without a stable implant. Type III fractures, which are further subclassified into types IIIa and IIIb, have an intact extensor mechanism but a loose patellar component. While type IIIa fractures have reasonable remaining bone stock, type IIIb fractures have poor bone stock. Type I patellar fractures may be best managed nonoperatively, but types II and III patellar fractures often necessitate surgical intervention. Patellectomy should be reserved for comminuted fractures, as well as fractures in patients with poor bone stock. Larger prospective randomized studies are necessary to better evaluate the treatment algorithm for patellar fractures following total knee arthroplasty.