Hemoglobinopathy is Associated With Total Hip Arthroplasty Indication Even Beyond Sickle Cell Anemia

Maxwell J. Rakutt, Daniel N. Bracey, Anna Cohen-Rosenblum, Peter K. Sculco, Franco M. Sabatini, Cale A. Jacobs, Stephen T. Duncan, David C. Landy

Research output: Contribution to journalArticlepeer-review


Background: The extent to which hemoglobinopathies other than sickle anemia (HbSS) are associated with hip osteonecrosis is unknown. Sickle cell trait (HbS), hemoglobin SC (HbSC), and sickle/β-thalassemia (HbSβTh) may also predispose to osteonecrosis of the femoral head (ONFH). We sought to compare the distributions of indications for a total hip arthroplasty (THA) in patients with and without specific hemoglobinopathies. Methods: PearlDiver, an administrative claims database, was used to identify 384,401 patients aged 18 years or older undergoing a THA not for fracture from 2010 to 2020, with patients grouped by diagnosis code (HbSS N = 210, HbSC N = 196, HbSβTh N = 129, HbS N = 356). β-Thalassemia minor (N = 142) acted as a negative control, and patients without hemoglobinopathy as a comparison group (N = 383,368). The proportion of patients with ONFH was compared to patients without it by hemoglobinopathy groups using chi-squared tests before and after matching on age, sex, Elixhauser Comorbidity Index, and tobacco use. Results: The proportion of patients with ONFH as the indication for THA was higher among those with HbSS (59%, P <.001), HbSC (80%, P <.001), HbSβTh (77%, P <.001), and HbS (19%, P <.001) but not with β-thalassemia minor (9%, P =.6) than the proportion of patients without hemoglobinopathy (8%). After matching, the proportion of patients with ONFH remained higher among those with HbSS (59% vs 21%, P <.001), HbSC (80% vs 34%, P <.001), HbSβTh (77% vs 26%, P <.001), and HbS (19% vs 12%, P <.001). Conclusions: Hemoglobinopathies beyond sickle cell anemia were strongly associated with having osteonecrosis as the indication for THA. Further research is needed to confirm whether this modifies THA outcomes.

Original languageEnglish
Article number101062
JournalArthroplasty Today
StatePublished - Feb 2023

Bibliographical note

Publisher Copyright:
© 2022 The Authors


  • Hemoglobinopathy
  • Osteoarthritis
  • Osteonecrosis
  • Sickle cell disease
  • Total hip arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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