A combined clinical and experimental study to investigate a potential model for improved osseointegration in sickle cell bone disease patients with avascular necrosis

  • Akintunde George

Student thesis: Doctoral ThesisDoctor of Medicine


The radiographic study showed clearly that sickle cell disease patients had well defined funnel shaped femurs but less so than the osteoarthritic cohort. This might allow for less press fit femoral component to be implanted and together with having less cortical thickness, there is a risk of occult and overt periprosthetic fractures which may contribute to femoral component loosening. The results from the experimental work confirmed that HIF could be up regulated in MG63 osteoblast cells in true hypoxic conditions made possible in the presence of cobalt chloride and that osteoblasts were viable despite the subnormal physiologic experimental conditions of hypoxia and cobalt chloride under which these cells were cultured.
From the clinical work undertaken, it was concluded that there might be structural reasons for the increased lack of osseointegration in sickle cell disease with femoral hip prosthesis. Furthermore, it was established that the experimental model used to investigate HIF expression and osteoblast cellular viability under hypoxic conditions could be deployed as an effective research tool for improving osseointegration in sickle disease patients with total hip replacement. It can be concluded from this work that cobalt chloride could be an agent for enhancing osseointegration, which is different from its current use as a bearing surface. This model could also be used in improving implant design to help address the increased total hip revision burden seen in these patients.
Date of Award19 Jun 2019
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorMarianne Ellis (Supervisor), Julian Chaudhuri (Supervisor) & Richie Gill (Supervisor)

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