Sickle cell disease (SCD) is one of the most common inherited hemoglobi-nopathies in the West African sub-region and is frequently complicated by musculoskeletal manifestations, especially avascular necrosis (AVN) of the femoral head. This complication can progress to femoral head collapse and secondary osteoarthritis, leaving total hip arthroplasty (THA) as the only definitive solution. However, THA in patients with SCD is fraught with unique challenges: altered bone morphology, poor bone quality, increased risk of intraoperative fracture, susceptibility to infection, and a higher likelihood of revision compared to standard populations. This review synthesizes the available literature on the clinical indications, perioperative optimization, surgical considerations, implant selection, and outcomes of THA in SCD. It highlights both the advances achieved and the persistent barriers to optimal outcomes, particularly in resourcelimited regions where the disease burden is greatest. While complications remain more frequent than in the general population, THA in SCD continues to demonstrate significant pain relief, improved function, and enhanced quality of life when performed in specialized settings with multidisciplinary care.
Cite this paper
Samson, O. O. and Bode, A. (2026). Total Hip Arthroplasty in Sickle Cell Disease: Implications and Challenges. Open Access Library Journal, 13, e14393. doi: http://dx.doi.org/10.4236/oalib.1114393.
Kumar, A. and Bhattacharya, S. (2024) Sickle Cell Disease: A Comparative Perspective on Glob-al and National Initiatives. Frontiers in Hematology, 3, Article 1457158. https://doi.org/10.3389/frhem.2024.1457158
Casale, M., Toro, G., Porcelli, F., et al. (2024) Long-Term Outcomes of Avascular Necrosis in Sickle Cell Disease. British Journal of Haematology, 206, 310-319.
Balogun, R.A., Obalum, D.C., Giwa, S.O., Adekoya-Cole, T.O., Ogo, C.N. and Enweluzo, G.O. (2010) Spectrum of Musculo-Skeletal Disorders in Sickle Cell Disease in Lagos, Nigeria. Journal of Orthopaedic Surgery and Research, 5, Article No. 2. https://doi.org/10.1186/1749-799x-5-2
Alshurafa, A., Soliman, A.T., de Sanctis, V., et al. (2023) Clinical and Epidemiological Features of Avascular Ne-crosis in Sickle Cell Disease. Acta Biomedica, 94, e2023198.
Calori, G.M., Mazza, E., Colombo, A., et al. (2017) Core Decompression and Biotechnologies in Femoral Head Osteonecrosis. EFORT Open Reviews, 2, 41-50.
Steinberg, M.E., Larcom, P.G., Strafford, B., et al. (2001) Core De-compression with Bone Grafting. Clinical Orthopaedics and Related Research, 386, 71-78.
Mohabey, A., De Joseph, J., Joseph, F.K., et al. (2025) Total Hip Arthroplasty in Sickle Cell Disease: Systematic Review and Meta-Analysis. Journal of Clinical Orthopaedics and Trauma, 67, Article 103060.
Akinyoola, A.L., Adediran, I.A. and Asaleye, C.M. (2007) Avascular Necrosis of Femoral Head in Sickle Cell Disease. Nigerian Postgraduate Medical Journal, 14, 217-220.
Hernigou, P., Habibi, A., Bachir, D. and Galacteros, F. (2007) Femoral Head Osteonecrosis in Sickle-Cell Disease. Clinical Orthopaedics and Related Research, 455, 88-95.
de Gheldere, A., Ndjoko, R., Docquier, P.L., et al. (2006) Ortho-paedic Complications Associated with Sickle-Cell Disease. Acta Orthopaedica Belgica, 72, 741-747.
Shah, K.N., Racine, J., Jones, L.C. and Aaron, R.K. (2015) Pathophysiology and Risk Factors for Osteonecrosis. Current Reviews in Musculoskeletal Medicine, 8, 201-209. https://doi.org/10.1007/s12178-015-9277-8
Aaron, F.E., Dublin-Green, L., Ijah, R.F.O., et al. (2024) Orthopedic Complications of Sickle Cell Disease in Port Harcourt, Nigeria. Advances in Clinical Medical Research, 5, 1-10.
GBD 2021 Sickle Cell Disease Collaborators (2023) Global, Regional, and National Prevalence and Mortality Burden of Sickle Cell Disease, 2000-2021. The Lancet Haematology, 10, E585-E599.
Geldenhuys, D.B., Cakic, J.N., Mokete, L., Sikhauli, N. and Pietrzak, J.R.T. (2025) An Increased In-cidence of Avascular Necrosis as the Predisposing Aetiology for Primary Total Hip Arthroplasty in Sub-Saharan Africa—A Retrospective Review of 1,400 Consecutive Patients. SICOT-J, 11, Article No. 54. https://doi.org/10.1051/sicotj/2025052
Hernigou, P., Bachir, D. and Galacteros, F. (2003) The Natu-ral History of Symptomatic Osteonecrosis in Adults with Sickle-Cell Disease. The Journal of Bone and Joint Surgery-American Volume, 85, 500-504. https://doi.org/10.2106/00004623-200303000-00016
Kenanidis, E., Kakoulidis, P., Lepetsos, P., Potoupnis, M., Tsiridis, E., Toğrul, E., et al. (2018) Sickle Cell Disease. In: The Adult Hip: Master Case Series and Techniques, Springer, 339-350. https://doi.org/10.1007/978-3-319-64177-5_12
Ugbeye, M.E., Lawal, W., Ayodabo, O., Dim, E. and Adegoke, S. (2020) Total Hip Arthroplasty in Sickle Cell Disease Patients in a Developing Country. Nigerian Journal of Clinical Practice, 23, 1426-1430. https://doi.org/10.4103/njcp.njcp_402_19
Katchy, A., Anyaehie, U., Nwadinigwe, C. and Eyichukwu, G. (2018) Total Hip Replacement in Sickle Cell Disorder: A Preliminary Report of Challenges and Early Outcome of 21 Consec-utive Patients. Nigerian Journal of Clinical Practice, 21, 492-495. https://doi.org/10.4103/njcp.njcp_182_17
Gu, A., Agarwal, A.R., Fassihi, S.C., Pollard, T.G., Stoll, W.T., Campbell, J.C., et al. (2023) Impact of Sickle Cell Disease on Postoperative Outcomes Following Total Hip Arthroplasty. HIP In-ternational, 33, 391-396. https://doi.org/10.1177/11207000211052224
Fox, J., Domingue, G.A., Demaio, C.V., Patrick, C.A., et al. (2024) Total Hip Arthroplasty Complications in Patients with Sickle Cell Disease: A Comparison Study. Vanderbilt University Orthopaedic Surgery, University of Oklahoma College of Medicine, Hudson Col-lege of Public Health, Department of Orthopedic Surgery and Rehabilitation and University of Oklahoma College of Medicine.
Estcourt, L.J., Kimber, C., Trivella, M., Doree, C. and Hopewell, S. (2020) Preoperative Blood Transfusions for Sickle Cell Disease. Cochrane Database of Systematic Reviews, 2020, CD003149. https://doi.org/10.1002/14651858.cd003149.pub4
Bayanzay, K. and Alzoebie, L. (2016) Reducing the Iron Burden and Improving Survival in Transfusion-Dependent Thalassemia Patients. Journal of Blood Medicine, 7, 159-169. https://doi.org/10.2147/jbm.s61540
Rahimi, Z. and Parsian, A. (2011) Sickle Cell Disease and Venous Thromboembolism. Mediterranean Journal of Hematology and Infectious Diseases, 3, e2011024. https://doi.org/10.4084/mjhid.2011.024
Vichinsky, E.P., Neu-mayr, L.D., Haberkern, C., Earles, A.N., Eckman, J., Koshy, M., et al. (1999) The Perioperative Complication Rate of Orthopedic Surgery in Sickle Cell Disease. American Journal of Hematology, 62, 129-138. https://doi.org/10.1002/(sici)1096-8652(199911)62:3<129::aid-ajh1>3.0.co;2-j
Adjepong, K.O., Otegbeye, F. and Adjepong, Y.A. (2018) Periopera-tive Management of Sickle Cell Disease: A Narrative Review. Mediterranean Journal of Hematology and Infectious Diseases, 10, Article 2018032. https://doi.org/10.4084/mjhid.2018.032
Clarke, H.J., Jinnah, R.H., Brooker, A.F. and Michaelson, J.D. (1989) Total Replacement of the Hip for Avascular Necrosis in Sickle Cell Disease. The Journal of Bone and Joint Surgery, 71, 465-470.
Honcharuk, E., Kayiaros, S. and Rubin, L.E. (2017) The Di-rect Anterior Approach for Acetabular Augmentation in Primary Total Hip Ar-throplasty. Arthroplasty Today, 4, 33-39. https://doi.org/10.1016/j.artd.2017.03.007
Giordano, P., Urbano, F., Lassandro, G. and Faienza, M.F. (2021) Mechanisms of Bone Impairment in Sickle Bone Disease. International Journal of Environmental Research and Pub-lic Health, 18, Article 1832. https://doi.org/10.3390/ijerph18041832
Almarzooq, O., Al-Bahrani, H., Al-Shammari, S., et al. (2023) Cemented vs Uncemented THA in Sickle Cell Dis-ease: Retrospective Study. Journal of Orthopaedic Surgery and Research, 15, e36138.
Jack, C.M., Howard, J., Aziz, E.S., Kesse-Adu, R. and Bankes, M.J. (2016) Cementless Total HIP Replacements in Sickle Cell Disease. HIP Interna-tional, 26, 186-192. https://doi.org/10.5301/hipint.5000317
Fowler, A.K., Gray, A.R. and Gwynne-Jones, D.P. (2019) Hybrid Fixation for Total Hip Arthroplasty: Single-Center Survival Analysis of 2156 Hips. The Journal of Ar-throplasty, 34, 2711-2717.
Higuchi, Y., Seki, T., Morita, D., Komatsu, D., Takegami, Y. and Ishiguro, N. (2019) Bearing Surface Wear Comparison. Re-vista Brasileira de Ortopedia, 54, 295-302.
Teixeira, T.R.G., Daltro, G.C., Sberge, F.L., Barreto, E.S.R. and da Silva, A.F. (2024) Stem Cell Therapy for Osteonecrosis in SCD. Frontiers in Cell and Developmental Biology, 12, Article 1410861.
Reina, N., Pareek, A., Krych, A.J., Pagnano, M.W., Berry, D.J. and Abdel, M.P. (2019) Dual-Mobility Constructs in THA. The Journal of Ar-throplasty, 34, 594-603.
