RESUMO
BACKGROUND: Sickle cell disease is the leading etiology for atraumatic humeral head avascular necrosis worldwide. Treatment of this condition is not standardized, with only few studies evaluating clinical outcomes after surgical interventions. The aim of this study was to review the available evidence on the results of surgical intervention for humeral head avascular necrosis in the sickle cell disease population. METHODS: A systematic electronic search was conducted using PubMed (MEDLINE), EMBASE, and Cochrane Library databases. Relevant studies that reported the outcomes of surgical intervention for humeral head avascular necrosis for patients with sickle cell disease were reviewed. Outcome parameters were pain, range of motion, specific shoulder outcome scores, and complications. RESULTS: Six studies, three retrospective cohorts (2 level III and 1 level IV) and three case series (level IV), were included in this review. A total of forty-three patients with sickle cell disease, comprising forty-nine shoulders, underwent different surgical procedures. Surgical procedures were core decompression, arthroscopic intervention, humeral head resurfacing, shoulder hemiarthroplasty, and total shoulder arthroplasty. CONCLUSION: Surgical intervention for humeral head avascular necrosis in patients with sickle cell disease is selected based on the osteonecrosis stage. In the precollapse stage, core decompression is regarded as the first surgical option. However, in the light of current evidence, it has not been confirmed to prevent or delay natural progression of the disease. Shoulder arthroplasty is reserved for late stages, which despite the fairly good outcomes, data for long-term implant survival and complications are not well documented.
RESUMO
INTRODUCTION AND IMPORTANCE: Breakage of the femoral stem with intact bone is a rare complication that has only been reported once. Sickle cell disease (SCD) patients are more prone to variable complications due to the nature of their disease. We discuss how to safely remove a fixed broken stem using an intramedullary trephine reamer to achieve optimal outcome in a SCD patient. It is important to keep an intact femoral cortex during arthroplasty to achieve stable prostheses. CASE PRESENTATION: We report a 35 years old SCD male, who complains of left hip pain and decreased activity 18-months following total hip arthroplasty with no history of trauma nor infection. Lab work and radiography showed signs of aseptic loosening and breakage of the femoral stem with no signs of cortical fractures. A trephine reamer was used to extract the stem during revision arthroplasty. Two years post-operative follow up showed improved Harris hip score (HHS) and apparent clinical improvement in function and pain. DISCUSSION: Multiple femoral stem extraction techniques have been reported in the literature. However, these approaches have variable disadvantages. Using the trephine reamer intramedullary helped to extract the distal femoral stem fragment and preserve the integrity of the femoral cortex. However, caution should be taken to avoid iatrogenic injuries. CONCLUSION: Using the trephine reamer to extract a broken femoral stem is a safe technique that preserves the cortical integrity. Complications of the trephine reamer include heat necrosis and iatrogenic fractures. Intra-operative measures can be taken to limit those complications.
