Iranian Journal of Orthopedic Surgery

Abstract Abstract
Corticosteroids are widely used medications with increasing prevalence in clinical practice. In autoimmune and rheumatological diseases, the use of corticosteroids in both pulsed and long-term manners is very common. Due to the COVID-19 pandemic, their consumption increased. However, long-term use is associated with several adverse effects on the musculoskeletal system, including osteoporosis, an elevated risk of fracture, avascular necrosis, hypocalcemia, hypovitaminosis D, and impaired bone growth in children. Corticosteroid-induced osteoporosis is the most common form of secondary osteoporosis. Several factors, such as age, time of use, family history of osteoporosis, previous fractures, and calcium intake, contribute to its prevalence. Corticosteroids exert their effects by disrupting the balance between the activity of osteoblasts and osteoclasts. These medications also disturb the calcium metabolism by altering intestinal calcium absorption and renal calcium excretion. To minimize these side effects, corticosteroid therapy should be limited whenever possible. Also, supplementing with calcium and vitamin D, incorporating breaks of at least three months between corticosteroid courses, and considering alternative therapies, especially in pediatric patients, can help mitigate the potential risks.

Abstract Sickle cell disease (SCD), often leads to skeletal complications such as avascular necrosis (AVN) of the femoral head, osteoporosis, fractures, and infections. Despite joint-preserving surgeries, many SCD patients require total hip arthroplasty (THA). However, THA carries significant risks for these patients, including hypoxia and vascular. This case report describes a 29-year-old female with SCD who presented with recurrent hip pain after a previous surgery was canceled due to a sickle cell crisis. Physical examination revealed restricted hip motion, and imaging confirmed AVN of the right femoral head. After a thorough hematology consultation, uncemented THA was performed. The surgery was uneventful, with minimal blood loss and no need for transfusion. The patient recovered well and was stable at her first follow-up. THA is common in SCD patients due to the high incidence of femoral head osteonecrosis, but they face higher risks of postoperative complications. Therefore, careful preoperative planning and coordination among surgical, anesthetic, and hematology teams are crucial for optimizing outcomes.