Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon
Part 7 of 12 in Spectrum of Orthopaedic Disorder - Evaluation and Management
Hip Replacement and Sickle Cell Disease: Why Blood Transfusion Comes First
September 6, 2026
Sickle cell disease causes avascular necrosis of the hip by blocking the small blood vessels that supply it, and Dr. Lamba was direct about the risk this creates in the operating room: surgery cannot simply proceed the way it would for any other patient.
Why the blood has to be prepared before surgery
Operating on a patient with sickle cell disease without preparation is not safe. Before any surgery, the proportion of sickle haemoglobin in the patient's blood has to be reduced through exchange blood transfusion, lowering the risk of a sickling crisis during and after the operation.
Operating one hip at a time
Once the blood has been prepared, surgery can proceed safely. Dr. Lamba's case involved both hips affected by the disease, and he addressed them one side at a time rather than together, to keep the physiological load on the patient manageable. The patient was able to stand and walk again afterward and went home satisfied with the outcome.
This article is based on a Jivo Masterclass session conducted by Dr. Rohit Lamba, Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rohit Lamba taught doctors across Africa on April 6, 2025.
FROM THE LIVE Q&A
Moderator
Which group of patients is hip replacement surgery indicated for?
Dr. Rohit Lamba
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
Frequently Asked Questions
Is there a definitive treatment for arthritis?▼
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
Which group of patients is hip replacement surgery indicated for?▼
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
Why does sickle cell disease complicate hip replacement surgery?▼
It causes avascular necrosis by blocking the small blood vessels supplying the hip, and operating without preparation raises the risk of a sickling crisis.
What has to happen before surgery in a sickle cell disease patient?▼
The proportion of sickle haemoglobin in the blood has to be reduced through exchange blood transfusion before surgery can proceed safely.
Are both hips operated on at the same time in these cases?▼
No. Dr. Lamba's case involved both hips, but they were addressed one side at a time to keep the physiological load on the patient manageable.
In This Series: Spectrum of Orthopaedic Disorder - Evaluation and Management
- 1.Spectrum of Orthopaedic Disorders
- 2.Understanding the Main Causes of Knee Arthritis
- 3.How Robotic and Computer-Navigated Systems Are Used in Joint Replacement
- 4.Developmental Dysplasia of the Hip: Treating a Childhood Hip Problem
- 5.Perthes Disease: When Childhood Hip Damage Surfaces Years Later
- 6.Avascular Necrosis of the Hip: Causes, Stages and Treatment
- 7.Hip Replacement and Sickle Cell Disease: Why Blood Transfusion Comes First
- 8.When Is Hip Replacement the Right Treatment?
- 9.ACL and Ligament Reconstruction: Grafts and When Surgery Is Needed
- 10.Treating Fracture Non-Union and Bone Infection with External Fixators
- 11.Reconstructing Severe Trauma: Distraction Osteogenesis for Bone and Limb Loss
- 12.Vitamin D Deficiency in Children: When Rickets Requires Corrective Knee Surgery