We reviewed retrospectively the results of total hip arthroplasties that were performed at one institution in young patients who had different types of sickle-cell Haemoglobinopathies to ascertain whether this form of therapy for Osteonecrosis of the hip was appropriate.

MATERIAL-METHOD. Between 1991–2005, 40 patients (24 females-16 males) who have sickle-cell anaemia (12 pts) and microdrepanocytic disease (28 pts), underwent a THR (4 pts bilaterally).The average age at the time of the primary operation was 42.5 yrs (range 18–57 yrs). Cemented, hybrid or uncemented prostheses were used in all cases.

Usually 4–5 blood units are needed perioperatively. Prophylatic antibiotic therapy and anticoagulation treatment always is used.

RESULTS. At the follow-up one patient had died because of haematological complications while was in the hospital. Three others have died of unknown to us reasons. The mean follow-up was 6 yrs-7 mo.

Thirty-six hips re-evaluated and according the Harris Hip Score in 17 the result was excellent, in 15 good and in 4 fair.

The main problem, during the operation, was the difficulty to open the femoral canal, which was very narrow and in some cases completely closed and the bone cortex very dense.

One patient had a revision procedure in two stages for septic loosening seven years after the primary THR. Four patients had a revision procedure for aseptic loosening between one and ten years after the primary operation.

The more serious complications during the surgical intervention were fracture of the greater trochanter in four cases and fracture of the diaphysis of the femur in four, also, cases.

CONCLUSIONS. In this cohort of patients with the multiple medical problems and the frequent admissions, total hip arthroplasty offers a satisfactory solution to the hip problem. However accurate patient selection and carefull multidisciplinary pre-, intra-and post-operative approache is mandatory, including detailed pre-operative examination, close collaboration with the haematologist, pre-operative red blood cell exchange, perioperative use of antibiotics, intra-operative care for preventions of crises of sickling and finaly antibiotic therapy in cases of dental interventions or catheterisms

Aim: Our aim was to record our experience with a fine needle 27G with any possible difficulties and side-effects.

Methods: 38 patients (26 men, 12 women) were selected for our study, aged 18–33 years. The underwent orthopedic surgery (femoral fractures, ankle surgery, patella, tibia and fibula fractures). The patients were preloaded with 500–700 ml crystalloid fluids.Lignocaine 2% (2–4ml) was injected for skin infiltration.

The spinal was performed in lateral positioning in O3–O4 or O4–O5 spaces. Bupivacaine (Marcaine 0.5%) was injected and clonidine (Catapresan) was added in 8 cases for prolonged anaesthesia. The injection was slow and the patients were evaluated in 1, 12, 24, 48 hours.

Results: Headache – technical difficulties – delayed action – nausea and vomiting and urine retention were recorded.

Headache. Even though all the patients were well informed for 24th bed rest, 2 of them suffered headache. They were treated with fluids, paracetamol, bed rest. No headache was noted after 72 hours.

Technical difficulties. Multiple tries were needed for successful spinal in 3 obese patients.

Delayed action. In 4 cases the onset of spinal anaesthesia took more than 20min. One patient was finally given general anaesthesia because of the spinal failure.

No urine retention was recorded.

Nausea – vomiting. 3 patients suffered nausea and were given ondasertron. No vomiting was recorded.

Conclusion: We conclude that spinal anaesthesia in young patients doesn’t cause severe side-effects nor technical difficulties. Headache, nausea, vomiting are less common in spinal than general anaesthesia.