Session Title: Virtual Poster Hall
Session Time: None. Available on demand.
Disclosures: Kevin J. Cipriano, MD: No financial relationships or conflicts of interest
Case Description: 48 year old male presented for planned right total hip arthroplasty (THA) for end stage osteoarthritis and avascular necrosis (AVN) refractory to all conservative management. Patient was initially scheduled to have both hips replaced, 2 days apart. Right THA was performed with anterior approach, however, greater trochanteric fracture was noted during surgery with comminution posteriorly, and it was converted to a posterior approach. Contralateral THA was postponed until after right hip recovered. Underlying etiology for OA and AN was unclear when admitted to inpatient rehab. Further workup at that time revealed sickle cell and alpha thalassemia trait which was thought to be the underlying cause of the AVN.
Setting: Inpatient Rehabilitation Facility
Patient: A 48-year-old male with chronic hip OA and a recent history of well-controlled HIV presented to inpatient rehabilitation following THA. Assessment/
Results: The osteoarthritis was previously attributed to idiopathic AVN. When the patient was admitted to inpatient rehabilitation, a further workup of the underlying cause of AVN in a 40 year old male was pursued. Labs revealed an abnormal blood smear, and hemoglobin electrophoresis showed a mixed sickle cell and alpha thalassemia trait. as the likely underlying cause. Hemoglobinopathy was thought to be the underlying cause of AVN.
Discussion: There are many different etiologies of end stage osteoarthritis. It is important to work up an underlying cause to guide early treatment and management of the musculoskeletal pathology as well as any potential hematologic diagnosis. Undiagnosed Hemoglobinopathies can lead to worsening Hip OA and lead to THA in younger individuals.
Conclusion: When OA occurs in relatively young individuals, a thorough workup should be performed to assess underlying etiology, especially in the setting of AVN. Hemoglobin electrophoresis should be considered.
Level of Evidence: Level V
To cite this abstract in AMA style:Cipriano KJ, White WD, Malmut L. Hemoglobinopathy Presenting as Bilateral Avascular Necrosis in Young Male [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/hemoglobinopathy-presenting-as-bilateral-avascular-necrosis-in-young-male/. Accessed September 24, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hemoglobinopathy-presenting-as-bilateral-avascular-necrosis-in-young-male/