Avascular necrosis of the femoral head due to sickle-cell disease in tribal population around Vishakhapatnam district, treated with core de-compression and non - vascularised fibular graft

Abstract

Sickle-cell disease (SCD) is the most common cause of avascular necrosis (AVN) of the hip in childhood. It results in significant physical impairment and chronic pain, and ohen progresses to require hip replacement. Conservative therapy is ineffective. We evaluated whether core decompression can arrest progression of AVN. We performed 10 core decompression procedures in 6 patients with SCD and AVN. Patients ranged from age 12—18 years at diagnosis (mean, median age, 14 years); Six hips were stage II, Four hips were stage III, and. follow-up on these patients was 1.2 years. Efficacy of the procedure was evaluated by clinical improvement in pain, radiographic progression, and need for further surgery. All 6 stage II patients had substantial improvement in pain, and only one showed X-ray progression. Both stage III patients progressed on X-ray, but one was clinically improved. One patient was operated with Non-Vascularised Fibular Graft. Our results demonstrate that in early AVN, core decompression was beneficial for almost all patients, even with progression on X-ray. Core decompression should be considered in the management of SCD patients with early AVN. But in our study, only one pt was operated with Non-Vascularised Fibular Graft