Effect of Sickle Cell Trait on Total Hip Arthroplasty in a Matched Cohort

Published:January 10, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.007


      • Patients with SCT have increased systemic complications after THA
      • Patients with SCT have higher rates of joint infection and loosening after THA
      • Hydration and pH homeostasis may reduce complications post THA in this cohort



      It is unclear if SCT carrier status conveys an increased risk for poor outcomes following total hip arthroplasty (THA). The purpose of this study was to compare short-term clinical outcomes of THA for patients with SCT versus matched controls.


      Patient records were queried from the PearlDiver database using ICD-9/ICD-10 and CPT codes. Patients with SCT who underwent THA were matched 1:1 with controls across age, gender, Elixhauser Comorbidity Index, obesity, and U.S. region. Thirty- and 90-day rates of systemic complications and 1- and 2-year rates of joint complications were compared with logistic regression.


      1,646 patients were assigned to each cohort. In the 30- and 90-day postoperative periods, SCT carriers had a higher likelihood of cerebrovascular accident, anemia, acute renal failure, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, and respiratory failure (all p < 0.05). SCT carriers exhibited significantly higher risk of prosthetic joint infection at both 1 (3.5% vs. 2.1%; OR: 1.91, 95% CI:1.22-2.99) and 2 years (3.7% vs. 2.6%; ORL 1.63, 95% CI: 1.07-2.49) postoperatively. Prosthetic loosening was also significantly more likely for SCT carriers within 1 year (1.3% vs 0.3%; OR: 4.49, 95% CI: 1.75-13.86).


      Patients with SCT exhibited significantly higher risk for systemic complications, periprosthetic joint infection, and prosthetic loosening after THA. Increased perioperative efforts should be made to prevent hypoxia, acidosis, and dehydration, as these states increase RBC sickling, which may reduce complication rates and improve outcomes in patients with SCT.

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