• Posted April 19, 2023

Knee Replacement More Challenging in People With Sickle Cell

While joint reconstruction surgeries are fairly common, they may be anything but routine for people with sickle cell disease.

Patients with the blood disorder who undergo total knee replacement are at a higher risk for complications than other patients, according to a new large-scale study.

"SCD patients undergoing total knee replacement need a multidisciplinary approach and may be better served in specialized centers capable of caring for these complex medical patients,"said study author Dr. Senthil Sambandam, an assistant professor of orthopedic surgery at University of Texas Southwestern Medical Center in Dallas.

"These patients have a higher risk of postoperative complications requiring the involvement of various specialists including nephrologists, pulmonologists and hematologists,"he explained in a UT Southwestern news release.

Skeletal and arthritic issues are common among sickle cell patients. About 100,000 people in the United States have the disease. As the life expectancy for these patients has increased over the years, so has the proportion of those needing joint reconstruction.

Researchers studied this using the National Inpatient Sample database to identify patients who underwent total knee replacement between 2016 and 2019.

The team divided patients into two groups: those with sickle cell disease and those without.

More than 558,000 patients had this surgery. Less than 1% -- 493 -- were known to have sickle cell disease. A greater proportion of them were younger, male and Black compared with non-sickle cell patients.

The analysis revealed that sickle cell patients were at a significantly higher risk of developing acute kidney failure, needing a blood transfusion and having deep vein thrombosis.

About 20% to 25% of them experienced other issues that included acute chest syndrome, pain crisis or splenic sequestration crisis (spleen enlargement) around the time of surgery. This may have contributed to the longer hospital stays and greater health care costs, the study found.

The findings highlight the importance of preventive strategies for sickle cell disease patients, including patient education and special joint health programs, Sambandam said.

The study findings were published in the Archives of Orthopaedic and Trauma Surgery.

More information

The U.S. Centers for Disease Control and Prevention has more on sickle cell disease.

SOURCE: UT Southwestern, news release, April 17, 2023