Non-operative Ambulatory Treatment Osteonecrosis of the Femoral Head in Sickle Cell Disease

Osteonecrosis of the femoral head of the femur (ONFH) is a common disabling complication in Sickle cell Disease (SCD). Sickle cell disorder include patients homozygous for hemoglobin S (HbSS) patients with sickle cell c (Hbsc) disease, those with sickle cell beta thalsaemia, and those who have other rare conditions in which Hbs is combined with abnormal beta globulin chains. ONFH in SCD is a result of erythroid hyperplasia or thrombosis and infarction. This stiff cells obliterate the microcirculation to the femoral head. The prognosis of ONFH in SCD depends on the age of the patient and the severity of involvement of the femoral head. It is characterized by pain in the hip without radiological sign during the early stage of the disease.
Specific features in late disease include small cysts, diffuse osteoporosis, subchondral osteoporosis/sclerosis, and a mixed osteoporosis/sclerosis. This stage last several months. Early diagnosis of ONFH increases the chances of treatment success. Plain X-rays are useful for late stage disease. Magnetic Resonance Imaging (MRI) is the most sensitive for diagnosing ONFH in the early stages. Treatment of ONFH in SCD depends on the stage of the disease. Surgical options include Core decompression, femoral osteotomy, pelvic osteotomy, hip arthrodesis, and total hip replacement arthroplaasty (THA). THA is indicated when the femoral head has collapsed and with arthritic changes. In this case series, short results on non-operative ambulatory treatment are presented.