Imaging of osteonecrosis of the femoral head in sickle cell patients: About 36 cases

Abstract

Purpose: To study the epidemiological, clinical and radiological aspects of osteonecrosis of the head of the femur in sickle cell patients.Methods: This was a retrospective study carried out at the Amirou Boubacar Diallo National Hospital in Niamey from January 2016 to December 2021. It involved 36 sickle cell patients aged 4 to 42 years (mean age = 16 years 7 months). All patients had a frontal x-ray of the pelvis. Scintigraphy was performed in 5 symptomatic patients due to persistence of pain while the pelvis x-ray was normal. The lesions were grouped according to their evolution according to the Arlet and FICAT classification.Results: In 36 patients, radiography revealed 26 cases of unilateral osteonecrosis of the head of the femur and 5 cases of bilateral involvement. In 5 patients who had a normal x-ray, the scintigraphy showed 3 cases of unilateral osteonecrosis of the femoral head at stage I. In total, 34 patients had osteoarticular lesions. These lesions were unilateral in 29 patients (85.29%) and bilateral in 5 patients (14.71%). In the majority of cases (79.41%) the lesions were diagnosed at late stages (III and IV of ARLET and FICAT classification).Conclusion: Osteonecrosis of the femoral head in sickle cell patients is a serious complication because of the often-significant after-effects. In our context, radiography remains the basic examination for diagnosis. In children, MRI, which is a non-irradiating modality, remains the examination of choice.