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Epidemiology and Perioperative Complications in Patients With Sickle Cell Disease After Orthopaedic Surgery: 26 Years' Experience at a Major Academic Center

Cusano, Joseph BS; Curry, Emily J. BA; Kingston, Kiera A. MD; Klings, Elizabeth MD; Li, Xinning MD

Journal of the American Academy of Orthopaedic Surgeons: December 1, 2019 - Volume 27 - Issue 23 - p e1043-e1051
doi: 10.5435/JAAOS-D-18-00288
Research Article

Introduction: Surgical management of patients with sickle cell disease (SCD) poses a unique challenge to orthopaedic surgeons due to increased operative and perioperative risk. Studies evaluating perioperative complications among patients with SCD undergoing orthopaedic surgery have been limited. We sought to review the clinical characteristics and perioperative complications in our patients with SCD who required orthopaedic surgery.

Methods: Our institution has one of the largest sickle cell centers in the Northeastern United States. We performed a retrospective chart review of all patients referred to the Orthopaedic Surgery Department between 1990 and 2016 and analyzed the demographics, comorbidities, surgical intervention, and perioperative complications.

Results: In total, 96 orthopaedic surgeries were surveyed across 26 years performed at our institution. The majority of the patients with SCD were African American (90.3%) and women (60.4%). The most common surgical intervention was for hip osteonecrosis. Only 11.5% of the patients (11 of 96) experienced a perioperative complication, with the vasoocclusive event being the most common (7 patients; 64%).

Discussion: These data suggest that orthopaedic surgery for a patient with SCD is safe but does require careful multidisciplinary consultation including hematology and anesthesia to medically optimize the patient before surgical intervention.

From the Department of Orthopaedic Surgery (Mr. Cusano, Ms. Curry, Dr. Kingston, Dr. Li), Boston University School of Medicine, and the Center of Excellence in Sickle Cell Disease (Dr. Klings), Boston University School of Medicine, Boston, MA.

Correspondence to Dr. Li:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Cusano, Ms. Curry, Dr. Kingston, Dr. Klings, and Dr. Li.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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