Outcomes and complications of total hip arthroplasty in patients affected by haematological disorder: a systematic review

Abstract

Purpose:

Total hip arthroplasty (THA) significantly enhances patients' quality of life. In the field of haematologic healthcare, hip replacement surgery is particularly relevant for those with conditions such as leukaemia, lymphoma, and myeloma. These patients often undergo extensive treatments, including chemotherapy and corticosteroids, which can lead to bone-related complications like avascular necrosis of the femoral head (ANFH). This systematic review explores the relationship between haematologic diseases and bone pathologies requiring THA.

Methods:

Data were collected from observational retrospective studies on hip arthroplasty in patients with haematologic disorder. Independent reviewers searched the literature, extracting relevant data according to PRISMA guidelines. We analysed 820 papers and included 10 observational studies in the review. Demographics, pathology, treatment, clinical outcomes, complications, survivorship, and follow-up were analysed.

Results:

The study included a total of 363 patients and 401 hips. The mean age of the patients was 39.5 years. The mean follow-up was 5 years. In the examined studies, most patients were diagnosed with acute lymphoid leukemia (5 out of 11 studies). Avascular necrosis of the femoral head was consistently recognised as the significant etiology for THA. All patients had received corticosteroid therapy in the past, and additional therapies included chemotherapy, radiation, and stem cell transplantation. The median period before surgery was 2.05 years. There were 29 complications that required surgical revision. Aseptic loosening was the cause of 41.95% revisions, impingement and instability for 22.58%, infection for 19.35%, and fracture for 9.67%. Minor causes include sinking and a fractured ceramic liner.

Conclusions:

THA is a safe and valuable procedure in patients with an ANFH history of haematological diseases and immunosuppressive treatments. Although THA presents higher complication rates in these patients compared to the general population, it has demonstrated satisfactory success rates.