The results of arthroplasty of the hip and other surgical procedures
that were performed in nine patients who had sickle-cell disease or
sickle-cell trait and osteonecrosis of the femoral head were not very
satisfactory. After an average duration of follow-up of 6.5 years (range,
two to 25.7 years), the complications were many and severe. Of eight
arthroplasties that were done for replacement of a joint, five required
early revision or excision: two, because of mechanical loosening; two,
because of sepsis; and one, due to a fracture of the prosthetic stem. There
was excessive perioperative blood loss, prolonged hospitalization, and
medical or surgical complications in all patients, including the three who
had sickle-cell trait and only slight manifestations of systemic disease. A
survivorship analysis of this series indicated that a failure rate of 50
per cent could be expected by 5.4 years postoperatively.