Unfortunately, this young patient belongs to the group that must be considered for THA in spite of the young age. I do not see any other option. Because of the osteonecrosis present , I do not think resurfacing comes into consideration. Maybe uncemented short stem could be used. Of course here the problem with the osteoporosis may be an additional difficulty which at the end would require cemented standard stemm.

I agree that apart from Bilateral THA there doesn't seem to be any other good option. I have done the same in this case. Any one having experience of doing such cases in single stage please share your experience

I wonder what is the bearing surface which has been used. At this age (25 years), ceramic on ceramic would be the preferred one.

If the cup size is too small (female patient), uncemented cups with integrated ceramic liner would be preferred to accommodate larger ceramic heads, e.g Delta motion from DePuy or Maxera from Zimmer. Even Aesculap has a similar monobloc cup. Smaller ceramic heads do have wear and impingement issues which would be best avoided.

We have been doing staged bilateral THR in such cases but avoid doing simultaneous bilateral THR. The risk of sickle cell crisis would be too high with the physiological stresses induced by bilateral THR!!! One has to be careful for such a crisis even in unilateral THR. Simultaneous bilateral is possible (as done in this case) but highly risky! Staging would be safer.

Just a comment about the stem used- Entry point for low profile lateral shoulder stems used in this case has been excessively lateralized leading to valgus positioning of stems. These stems have been designed to have entry point a bit medial to the one used by you so as to enable preservation of Piriformis.

Late in the discussion I agree for with the treatment of bilateral total joints and seems that all is perfect. About CoC I would agree as possibly this will give longer surviroship than the CoPoly. Despite this there are people who insert high crosslinked poly and have great results. Potential problem with the CoC is squicking and in case a revision would be considered as necessary the ceramic insert is difficult to be separated from the metal cell.

I had used MDM, dual mobility cup and a proximally coated stem (Accolade) of Stryker in this case

This is great as, if I am correct, there are within the culture some local habits, like to sit in deep flexion or using a cross leg position, so your choice accommodates these movements.

Tx for your inputs. I did bilateral simultaneous procedure in this thin built young lady. She was discharged after 5 days of the procedure.

Though hip arthroplasty remains the mainstay of management of arthritic hip in sickle cell anaemia, simultaneous bilateral hip arthroplasty is a highly risky affair. Congratulations on being able to avoid early complications!

Lucky for the patient to get away without sickle cell crisis as simultaneous bilateral THR would impose severe stress on patient's physiology. It is presumed that patient was managed with haematologist as a part of the team perioperatively.

A recent review article on the issue of hip arthroplasty in sickle cell anaemia published in World Journal of Orthopaedics is attached for everyone who is interested in this challenging clinical scenario.

Please also find attached the strategy to manage such patients perioperatively!

Article Management Strategies for Total Hip Arthroplasty in Sickle C...

This is an interesting case and I would personally advocate staged bilateral THR's using a Ceramic on Highly crossed linked PE bearing combination. I would not offer single-anaesthetic bilateral THR in this case for the reasons that are well made in the discussion above. Cemented stems done appropriately would work very well.

I appreciate that bilateral simultaneous THA is not only carries higher risks of complications but also quite challenging. Hence, selection of a case is of Paramount importance

You are right. In similar risky cases I would prefer two stage THA. 

Simultaneous operations for any joint, at any patient are riskier than single; this is known. Selection of appropriate cases has to be done, as it is mentioned. Support for such cases has to be provided by multidisciplinary teams, as this also said.

Yes, it is also said. In this specific case the risk is dircetly related tothe necessity of blood transfusion and a higher risk of provoked hemolytic crisis which can lead to kidney problems. 

In cases where blood management is of more than usual importance, I would especially pay attention to the surgical approach. In such a case a less invasive anterior approach without compromising any muscle would be preferred. Given the specific instruments, even endoprostetic shafts of normal lenght can be used, but I would prefer a short stem.

Even if there is only minimal blood loss, I would still prefer a two stage THA.

I do agree that doing staged surgery is more safer but in this case due to her younger age, no major comorbidity and overseas patient status, we chose to do bilateral single staged surgery. This was successful and the patient was discharged 5 days after the surgery and ready to travel back home in 3 weeks.  So we need to individualize each case and no hard and fast rules can be made for such complex problems.

Your experience with this young patient is very encouraging, thank you for sharing this with us. May I ask which surgical approach you have chosen?

I have an experience of more than 50 cases of SCD where simultaneous bilateral THA was done. I do it by modified Hardinge's lateral approach.