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The Journal of Bone and Joint Surgery 82:1231 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Arthroplasty of the Hip in Patients with Aplastic Anemia*

Yong Sik Kim, M.D.{dagger}, John J. Callaghan, M.D.{ddagger}, Soon Yong Kwon, M.D.{dagger}, Ki Won Kim, M.D.{dagger}, Chi Hwa Han, M.D.{ddagger} and Young Kyun Woo, M.D.{dagger}

Investigation performed at the Department of Orthopaedic Surgery and Internal Medicine, St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
*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. No funds were received in support of this study.
{dagger}Departments of Orthopaedic Surgery (Y. S. K., S. Y. K., K. W. K., and Y. K. W.) and Internal Medicine (C. H. H.), St. Mary's Hospital, The Catholic University of Korea, 62 Yoido-Dong, Youngdeungpo-Ku, Seoul 150-010, Korea.
{ddagger}Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 01073 JPP, 200 Hawkins Drive, Iowa City, Iowa 52242-1088. E-mail address: john-callaghan{at}uiowa.edu

Background: Patients with aplastic anemia are now living longer and therefore are at increased risk for the development of osteonecrosis of the hip. However, studies on the results of arthroplasty for the treatment of osteoarthritis of the hip in patients with aplastic anemia are lacking.

Methods: Twenty-six primary hip prostheses (one bipolar prosthesis fixed with cement, two bipolar prostheses fixed without cement, three hybrid total hip prostheses, and twenty total hip prostheses fixed without cement) were implanted, between March 1990 and May 1992, in nineteen patients who had been diagnosed with aplastic anemia. A specific prospective protocol was followed for the perioperative transfusion of platelets and blood. Twenty-five hips were replaced because of osteonecrosis of the femoral head, and one was replaced because of a femoral neck fracture. The patients were followed prospectively, with preoperative and serial postoperative Harris hip ratings as well as radiographs, for a minimum of six years or until death.

Results: No patient had excessive perioperative bleeding or a postoperative infection. After a mean duration of follow-up of seventy-nine months (range, seventy-two to ninety-five months), two patients had died with the original implant in place. No patients were lost to follow-up. The mean Harris hip score was 55 points (range, 42 to 68 points) preoperatively and 87 points (range, 56 to 95 points) at the time of the latest follow-up. At the time of this writing, no hip had been revised. One patient with a bipolar prosthesis had radiographic evidence of femoral loosening and will probably require revision. A second patient had some medial protrusion of a bipolar prosthesis, with mild symptoms. All of the acetabular components that had been fixed without cement and all of the other femoral components appeared to be stable on radiographs after a minimum of seventy-two months of follow-up.

Conclusions: Total hip arthroplasty can be performed safely in patients with aplastic anemia. In the present intermediate-term study, the durability of implant fixation was maintained and the clinical results demonstrated a sustained increase in function of the hip.


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