HIP PATHOLOGIES THAT BEDEVIL
Osteonecrosis of the femoral head THE TOTAL HIP REPLACEMENT SOLUTION
K. Issa, R. Pivec, B. H. Kapadia, S. Banerjee, M. A. Mont From Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland, United States
Symptomatic hip osteonecrosis is a disabling condition with a poorly understood aetiology and pathogenesis. Numerous treatment options for hip osteonecrosis are described, which include non-operative management and joint preserving procedures, as well as total hip replacement (THR). Non-operative or joint preserving treatment may improve outcomes when an early diagnosis is made before the lesion has become too large or there is radiographic evidence of femoral head collapse. The presence of a crescent sign, femoral head flattening, and acetabular involvement indicate a more advanced-stage disease in which joint preserving options are less effective than THR. Since many patients present after disease progression, primary THR is often the only reliable treatment option available. Prior to the 1990s, outcomes of THR for osteonecrosis were poor. However, according to recent reports and systemic reviews, it is encouraging that with the introduction of newer ceramic and/or highly cross-linked polyethylene bearings as well as highly-porous fixation interfaces, THR appears to be a reliable option in the management of end-stage arthritis following hip osteonecrosis in this historically difficult to treat patient population. Cite this article: Bone Joint J 2013;95-B, Supple A:46–50.
K. Issa, MD, Research fellow R. Pivec, MD, Research fellow B. H. Kapadia, MD, Research fellow S. Banerjee, MD, Research fellow M. A. Mont, MD, Director of Orthopedics Sinai Hospital of Baltimore, 2401 W Belvedere Ave Baltimore, Maryland 21215, USA. Correspondence should be sent to Mr M. A. Mont; e-mail:
[email protected] ©2013 The British Editorial Society of Bone & Joint Surgery doi:10.1302/0301-620X.95B11. 32644 $2.00 Bone Joint J 2013;95-B, Supple A:46–50. Received 2 August 2013; Accepted after revision 2 August 2013
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Osteonecrosis of the femoral head is a debilitating and potentially devastating condition that has a poorly understood pathogenesis and wide-ranging aetiologies.1,2 The most common risk factors are shown in Table I. The most commonly reported laboratory abnormalities include decreased function and concentration of fibrinolytic agents, as well as increased levels of thrombophilic agents.3 There is no universal consensus regarding the optimal algorithm that can be used to treat patients who have different stages of this condition (Fig. 1). However, nonoperative management of hip osteonecrosis includes drugs such as bisphospohanates,4-10 anticoagulants,11,12 hypolidemeics,13,14-18 vasodilators,19,20 or non-operative procedures such as extra-corporeal shock wave treatment,21-23 pulsed electromagnetic therapy,24 or hyperbaric oxygen25,26 which have all shown efficacy in the reduction of pain, and improved function during early-stages of the condition. During early-stage disease, joint preserving procedures such as core decompression or percutaneous drilling27-30 may increase blood flow to the necrotic area by reducing the intra-osseous pressure, thus alleviating pain and improving function. Unfortunately, many of these patients commonly present when they have large lesions, or have progressed to collapse of the femoral head (Figs 2 and 3). In such cases,
total hip replacement (THR) is the only option (Fig. 4).
The THR solution THR is often the only reliable treatment in reducing pain and restoring mobility in patients who have collapse of the femoral head secondary to osteonecrosis. It is estimated that in the United States, approximately 10% of all THRs are performed for symptomatic hip osteonecrosis.31,32 However, historically THR for osteonecrosis has quite poor results. During the 1980s and early 1990s studies by Cornell, Salvati and Pellicci,33 Stauffer.34 and Chandler et al35 reported failure rates of between 37% to 53% at approximately five years follow up. These studies made use of ‘first-generation’ cementing techniques and older prosthetic designs. However, according to recent reports this is not the case in the new millennium.36-43 In a systemic review of 67 studies that represented 3277 THRs for osteonecrosis of the femoral head in 2593 patients, Johannson et al37 reported that after the 1990s, survivorship of primary THRs were superior compared with those performed earlier, with a mean 97% survivorship at six years follow-up. These outcomes were comparable with the results of this procedure for end-stage primary osteoarthritis. In addition, stratification of outcomes by CCJR SUPPLEMENT TO THE BONE & JOINT JOURNAL
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Table I. Risk factors for osteonecrosis of the Hip Direct
Indirect
Trauma/dislocation Radiation Sickle cell disease Caisson disease Myeloproliferative disorders
Alcohol abuse Chronic corticosteroids Coagulation disorders Statins Human immunodefiency virus (HIV) Systemic lupus erythematosus (SLE) Pregnancy
Hip pain with associated risk factors
Bilateral x-ray of hips Yes Presence of radiographic findings?
MRI showing No disease?
Yes
No
Stage I disease: • Core decompression or percutaneous decompression
If no disease present on MRI search for other sources of hip pain or repeat in 6 months
Diffuse sclerosis, subchondral cysts on x-ray
Stage II disease: Mild • Core decompression, NVBG Moderate • NVBG, VBG Severe • NVBG, VBG, osteotomy
Subchondral fracture with or without presence of collapse of femoral head
Stage III disease: Mild • NVBG, VBG, total hip resurfacing, THR Moderate • Total hip resurfacing, THR Severe • Total hip resurfacing, THR
Femoral head collapse, acetabular involvement, joint destruction
Stage IV disease: • Total hip resurfacing, THR
Fig. 1 Treatment algorithm for hip osteonecrosis based on the presenting stage of the disease. (VBG, vascularised bone grafting; NVBG, non-vascularised bone grafting; THR, total hip replacement). Used with permission from Sinai Hospital of Baltimore, Inc.
associated risk factors demonstrated significantly higher revision rates in patients who had sickle cell disease (p < 0.001), Gaucher disease (p = 0.013), or end-stage kidney failure and/or transplant (p = 0.002), and significantly lower revision rates in patients who had systemic lupus erythematosus,36 idiopathic disease, or after heart transplant. VOL. 95-B, No. 11, NOVEMBER 2013
Tribological advances in the past two decades have led to the development of effective ceramic-on-ceramic and ultrahigh molecular weight polyethylene bearings in THR.44,45 These bearings have low wear rates and show promise when used in patients with end-stage osteonecrosis at midterm follow-up. In a study of 73 THRs for osteonecrosis
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K. ISSA, R. PIVEC, B. H. KAPADIA, S. BANERJEE, M. A. MONT
Fig. 2
Fig. 4
Anteroposterior hip radiograph demonstrating late-stage hip osteonecrosis. Used with permission from Sinai Hospital of Baltimore, Inc.
Five-year follow-up anteroposterior hip radiograph after primary THR. Used with permission from Sinai Hospital of Baltimore, Inc.
Fig. 3 MRI scan of hip demonstrating bilateral osteonecrosis of the femoral heads. Used with permission from Sinai Hospital of Baltimore, Inc.
and at mean follow-up of 8.5 years (7 to 9), Kim, Choi and Kim44 reported 100% survivorship (excluding infection) and mean linear wear of 0.05 mm/year (SD 0.02) using alumina ceramic heads on highly cross-linked polyethylene acetabular bearings. Similarly, in a study of 162 THRs with highly cross-linked polyethylene bearings, Min et al45 reported 100% survivorship (excluding infection) and a linear wear rate of 0.037 mm/year (0 to 0.099) at a mean follow-up of 7.2 years (5 to 10.6). Other long-term studies have also shown improved results compared with earlier reports. In a study of 148 THRs, Kim et al46 reported 98% stem survivorship (cemented and cementless) but only 85% cementless cup survivorship at mean follow-up of 17.3 years (16 to 18); the
most common reason for revision was related to cup wear or loosening. Although, cup failure is more common than stem failure even in non-osteonecrotic THRs, Titanium or Tantalum highly-porous acetabular cups have shown excellent survivorship in non-osteonecrotic hips at short-term follow-up.47-49 For example, Naziri et al48 evaluated 288 cementless THRs performed using a highly-porous titanium acetabular cup in 252 patients and reported 100% survivorship (excluding infection) at a mean follow-up of 36 months (24 to 56). Although longer-term studies are necessary to evaluate these acetabular components in the setting of osteonecrosis, promising stem and cup survivorships appears to be achievable. Many studies have reported that the outcomes of primary THR have not been affected by previous hip joint preserving procedures at mid-term follow-up.50-55 Helbig et al56 demonstrated no complications or component loosening, at a mean follow-up of 54 months in series of 15 hips, that were converted to THR after they had previous core decompression. In a study of 15 failed trans-trochanteric rotational osteotomies that were converted to THR, Kawasaki et al50 reported no significant differences in implant survivorship, stability, or Harris hip score57 compared with a matching group of 16 hips that had only undergone a primary THR at a mean follow-up of five years. Ball, Le Duff, and Amstutz53 compared 21 failed hip resurfacings that were converted to a standard THR, with 64 standard THRs (both cohorts included osteonecrosis patients), and reported no differences in aseptic loosening, dislocations, Harris hip score or complications between the two groups. Issa et al39 evaluated 92 hips in 87 patients who had failed prior hip preserving surgery (35 hips that had previous resurfacing, 9 hips that had a hemi-resurfacing, 29 hips that had a non-vascularised bone grafting, and 19 that had a core decompression). These patients were CCJR SUPPLEMENT TO THE BONE & JOINT JOURNAL
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compared with 121 hips in 105 osteonecrosis patients who underwent THR and had no prior surgical interventions. At a mean follow-up of 75 months, they reported no significant differences in survivorship, clinical, and radiological outcomes among the groups.
THR for osteonecrosis in high-risk groups As described earlier, patients who have sickle cell disease, Gaucher disease, or end-stage kidney failure and/or posttransplantation have been reported to be at an increased risk for revision following total hip arthroplasty.37 However, even in these high-risk groups, outcomes of THR have improved over time.58-60 Ilyas and Moreau58 evaluated 18 consecutive patients with a mean age of 28 years (17 to 39) who had undergone simultaneous bilateral cementless bipolar hip replacements. At a mean follow-up of 5.7 years (2 to 10) they reported that no femoral stem was revised. Issa et al43 evaluated 42 THRs for osteonecrosis in 32 sickle cell patients who had a mean age of 37 years compared with 102 THRs in 87 non-sickle cell osteonecrosis patients who had a mean age of 43 years. At a mean follow-up of seven years (3 to 10.5), they reported no significant differences in aseptic implant survivorship (95% versus 97%), Harris hip score (87 versus 88), and SF-36 physical61 (43 versus 44) or mental component scores (59 versus 58) between the two patient cohorts respectively. Marulanda et al59 compared the outcomes of two types of peri-operative management (conservative or aggressive protocols) in three patients who had sickle cell anaemia and had undergone 31 separate orthopaedic surgeries for osteonecrosis of the femoral head. In the conservative protocol, patients received packed red blood cells pre-operatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given only when excessive bleeding occurred intraoperatively. In the aggressive protocol, patients received pre-operative packed red blood cells with the goal of keeping haemoglobin levels between 9 g/dl and 11 g/dl, and of lowering the haemoglobin S levels to < 30%. Fresh frozen plasma was given when patients’ Factor VII levels were less than 30%. They reported although both protocols were safe in managing these patients, the more aggressive protocol had resulted in lower rates of post-operative complications, transfusions, and the need to resort to supplementary oxygen. Chang et al60 evaluated 74 hips in 52 patients who underwent THR for osteonecrosis of the femoral head after kidney transplantation with cementless THRs. They reported 96.6% cumulative implant survivorship at a mean follow-up of 10.2 years, which is comparable with survivorship due to other causes of THR. In light of these findings, the outcomes of THR even in these high-risk patients are improving, potentially due to improved medical and surgical management, as well as the use of modern prosthetic designs, including cementless acetabular and femoral fixation.59,62-67 VOL. 95-B, No. 11, NOVEMBER 2013
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Conclusion In summary, there have been marked improvements in the current knowledge and management of osteonecrosis of the femoral head in recent decades. Patients who are at risk of developing osteonecrosis should be diagnosed early, mainly because small or medium-sized pre-collapse lesions may be treated with non-operative and joint preservation procedures. Unfortunately, many patients present with late-stage disease when the joint is not salvageable and likely to require a primary THR. It is encouraging that with the introduction of the newer ceramic or highly cross-linked polyethylene bearings as well as highly-porous fixation interfaces, THR appears to be a reliable treatment option for management of end-stage arthritis following hip osteonecrosis in this historically difficult to treat patient population. M. A. Mont receives royalties from Stryker; is a consultant for Janssen, Sage Products, Inc., Salient Surgical, Stryker, OCSI, TissueGene; receives institutional support from Stryker; and is on the Speakers Bureau for Sage Products, Inc. B. H. Kapadia is a consultant and on Speakers’ Bureau for Sage products Inc. The remaining authors have no disclosures. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This paper is based on a study which was presented at the 29th Annual Winter 2012 Current Concepts in Joint Replacement® meeting held in Orlando, Florida, 12th – 15th December.
References 1. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg [Am] 1995;77-A:459–474. 2. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg [Am] 2006;88-A:1117–1132. 3. Orth P, Anagnostakos K. Coagulation abnormalities in osteonecrosis and bone marrow edema syndrome. Orthopedics 2013;36:290–300. 4. Plenk H Jr, Gstettner M, Grossschmidt K, et al. Magnetic resonance imaging and histology of repair in femoral head osteonecrosis. Clin Orthop Relat Res 2001;386:42–53. 5. Glimcher MJ, Kenzora JE. The biology of osteonecrosis of the human femoral head and its clinical implications III: discussion of the etiology and genesis of the pathological sequelae: commments on treatment. Clin Orthop Relat Res 1979;140:273–312. 6. Lai KA, Shen WJ, Yang CY, et al. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis: a randomized clinical study. J Bone Joint Surg [Am] 2005;87-A:2155–2159. 7. Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip: a prospective open-label study. Rheumatology (Oxford) 2005;44:352–359. 8. Agarwala S, Shah SB. Ten-year follow-up of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty 2011;26:1128–1134. 9. Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg [Br] 2009;91-B:1013–1018. 10. Rodan GA, Fleisch HA. Bisphosphonates: mechanisms of action. J Clin Invest 1996;97:2692–2696. 11. Glueck CJ, Freiberg RA, Sieve L, Wang P. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop Relat Res 2005;435:164–170. 12. Glueck CJ, Freiberg RA, Wang P. Role of thrombosis in osteonecrosis. Curr Hematol Rep. 2003;2:417–422. 13. Zhao FC, Li ZR, Guo KJ. Clinical analysis of osteonecrosis of the femoral head induced by steroids. Orthop Surg 2012;4:28–34. 14. Wolverton SE. Can short courses of systemic corticosteroids truly cause osteonecrosis? Dermatol Ther 2009;22:458–464. 15. Weldon D. The effects of corticosteroids on bone: osteonecrosis: avascular necrosis of the bone. Ann Allergy Asthma Immunol 2009;103:91–97. 16. Weinstein RS. Glucocorticoid-induced osteonecrosis. Endocrine 2012;41:183–190. 17. Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop Relat Res 2001;386:173–178. 18. Ajmal M, Matas AJ, Kuskowski M, Cheng EY. Does statin usage reduce the risk of corticosteroid-related osteonecrosis in renal transplant population? Orthop Clin North Am 2009;40:235–239.
50
K. ISSA, R. PIVEC, B. H. KAPADIA, S. BANERJEE, M. A. MONT
19. Jager M, Tillmann FP, Thornhill TS, et al. Rationale for prostaglandin I2 in bone marrow oedema: from theory to application. Arthritis Res Ther 2008;10:R120. 20. Disch AC, Matziolis G, Perka C. The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg [Br] 2005;87-B:560–564. 21. Alves EM, Angrisani AT, Santiago MB. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 2009;28:1247–1251. 22. Ludwig J, Lauber S, Lauber HJ, et al. High-energy shock wave treatment of femoral head necrosis in adults. Clin Orthop Relat Res 2001;387:119–126. 23. Hsu SL, Wang CJ, Lee MS, et al. Cocktail therapy for femoral head necrosis of the hip. Arch Orthop Trauma Surg 2010;130:23–29. 24. Massari L, Fini M, Cadossi R, Setti S, Traina GC. Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head. J Bone Joint Surg [Am] 2006;88-A(Suppl):56–60. 25. Camporesi EM, Vezzani G, Bosco G, Mangar D, Bernasek TL. Hyperbaric oxygen therapy in femoral head necrosis. J Arthroplasty 2010;25(Suppl):118–123. 26. Reis ND, Schwartz O, Militianu D, et al. Hyperbaric oxygen therapy as a treatment for stage I avascular necrosis of the femoral head. J Bone Joint Surg [Br] 2003;85-B:371–375. 27. Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg [Am] 1991;73-A:1357– 1364. 28. Israelite C, Nelson CL, Ziarani CF, et al. Bilateral core decompression for osteonecrosis of the femoral head. Clin Orthop Relat Res 2005;441:285–290. 29. Plakseychuk AY, Kim SY, Park BC, et al. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg [Am] 2003;85-A:589–596. 30. Seyler TM, Marker DR, Ulrich SD, Fatscher T, Mont MA. Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis. Clin Orthop Relat Res 2008;466:1125–1132. 31. Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg 1999;7:250–261. 32. Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect 2000;49:169– 185. 33. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am 1985;16:757–769. 34. Stauffer RN. Ten-year follow-up study of total hip replacement. J Bone Joint Surg [Am] 1982;64-A:983–990. 35. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old: a five-year follow-up study. J Bone Joint Surg [Am] 1981;63-A:1426–1434. 36. Issa K, Naziri Q, Rasquinha VJ, et al. Outcomes of primary total hip arthroplasty in systemic lupus erythematosus with a proximally-coated cementless stem. J Arthroplasty 2013;Epub. 37. Johannson HR, Zywiel MG, Marker DR, et al. Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthop 2011;35:465–473. 38. Baek SH, Kim SY. Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg [Am] 2008;90-A:1314–1320. 39. Issa K, Johnson AJ, Naziri Q, et al. Hip osteonecrosis: does prior hip surgery alter outcomes compared to an initial primary total hip arthroplasty? J Arthroplasty 2013;Epub. 40. Mont MA, Seyler TM, Plate JF, Delanois RE, Parvizi J. Uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head: a comparative study. J Bone Joint Surg [Am] 2006;88-A(Suppl):104–109. 41. Seyler TM, Bonutti PM, Shen J, Naughton M, Kester M. Use of an alumina-onalumina bearing system in total hip arthroplasty for osteonecrosis of the hip. J Bone Joint Surg [Am] 2006;88-A(Suppl):116–125. 42. Wang TI, Hung SH, Su YP, et al. Noncemented total hip arthroplasty for osteonecrosis of the femoral head in elderly patients. Orthopedics 2013;36:271–275. 43. Issa K, Naziri Q, Maheshwari AV, et al. Excellent results and minimal complications of total hip arthroplasty in sickle cell hemoglobinopathy at mid-term follow-up using cementless prosthetic components. J Arthroplasty 2013;Epub.
44. Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with alumina-on-highly cross-linked polyethylene bearing in young patients with femoral head osteonecrosis. J Arthroplasty 2011;26:218–223. 45. Min BW, Lee KJ, Song KS, Bae KC, Cho CH. Highly cross-linked polyethylene in total hip arthroplasty for osteonecrosis of the femoral head: a minimum 5-year followup study. J Arthroplasty 2013;28:526–530. 46. Kim YH, Kim JS, Park JW, Joo JH. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise followup, at an average of seventeen years, of a previous report. J Bone and Joint Surg [Am] 2011;93-A:1806–1810. 47. Macheras G, Kateros K, Kostakos A, et al. Eight to ten year clinical and radiographic outcome of a porous tantalum monoblock acetabular component. J Arthroplasty 2009;24:705–709. 48. Naziri Q, Issa K, Pivec R, et al. Excellent results of primary THA using a highly porous titanium cup. Orthopedics 2013;36:390–394. 49. Malizos KN, Bargiotas K, Papatheodorou L, Hantes M, Karachalios T. Survivorship of monoblock trabecular metal cups in primary THA : midterm results. Clin Orthop Relat Res 2008;466:159–166. 50. Kawasaki M, Hasegawa Y, Sakano S, Masui T, Ishiguro N. Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Arthroplasty 2005;20:574–579. 51. McGrath MS, Marker DR, Seyler TM, Ulrich SD, Mont MA. Surface replacement is comparable to primary total hip arthroplasty. Clin Orthop Relat Res 2009;467:94–100. 52. Gilbert RE, Cheung G, Carrothers AD, Meyer C, Richardson JB. Functional results of isolated femoral revision of hip resurfacing arthroplasty. J Bone Joint Surg [Am] 2010;92-A:1600–1604. 53. Ball ST, Le Duff MJ, Amstutz HC. Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg [Am] 2007;89-A:735– 741. 54. Beaulé PE, Schmalzried TP, Campbell P, Dorey F, Amstutz HC. Duration of symptoms and outcome of hemiresurfacing for hip osteonecrosis. Clin Orthop Relat Res 2001;385:104–117. 55. Cuckler JM, Moore KD, Estrada L. Outcome of hemiresurfacing in osteonecrosis of the femoral head. Clin Orthop Relat Res 2004;429:146–150. 56. Helbig L, Simank HG, Kroeber M, et al. Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2012;132:1095–1103. 57. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg [Am] 1969;51-A:737–755. 58. Ilyas I, Moreau P. Simultaneous bilateral total hip arthroplasty in sickle cell disease. J Arthroplasty 2002;17:441–445. 59. Marulanda GA, Minniti CP, Ulrich SD, Seyler TM, Mont MA. Perioperative management for orthopaedic patients with sickle cell anaemia. J Orthop Surg 2009;17:346–350. 60. Chang JS, Han DJ, Park SK, Sung JH, Ha YC. Cementless total hip arthroplasty in patients with osteonecrosis after kidney transplantation. J Arthroplasty 2013;28:824–827. 61. Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 1993;306:1437–1440. 62. Kapadia BH, Johnson AJ, Daley JA, Issa K, Mont MA. Pre-admission cutaneous chlorhexidine preparation reduces surgical site infections in total hip arthroplasty. J Arthroplasty 2013;28:490–493. 63. Hammer M, Geier KA, Aksoy S, Reynolds HM. Perioperative care for patients with sickle cell who are undergoing total hip replacement as treatment for osteonecrosis. Orthop Nurs 2003;22:384–397. 64. dos Santos JL, Lanaro C, Chin CM. Advances in sickle cell disease treatment: from drug discovery until the patient monitoring. Cardiovasc Hematol Agents Med Chem 2011;9:113–127. 65. Friedrich MJ. Advances reshaping sickle cell therapy. JAMA 2011;305:239–240. 66. Inati A. Recent advances in improving the management of sickle cell disease. Blood Rev 2009;23(Suppl):9–13. 67. Kapadia BH, Pivec R, Johnson AJ, et al. Infection prevention methodologies for lower extremity total joint arthroplasty. Expert Rev Med Devices 2013;10:215–224.
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