CORE DECOMPRESSION IN AVASCULAR NECROSIS OF THE HIP IN SICKLE-CELL DISEASE

Sickle-cell disease (SCD) is the most common cause of avascular necros is (AVN) of the hip in childhood. It results in significant physical i mpairment and chronic pain, and often progresses to require hip replac ement. Conservative therapy is ineffective. We evaluated whether core decompression can arrest progression of AVN. We performed 13 coring pr ocedures in 10 patients with SCD and AVN. Patients ranged from age 9-2 1 years at diagnosis (mean, median age, 15 years); five hips were stag e I, six hips were stage II, and two hips were stage III. Mean follow- up on these patients was 3.7 years. Efficacy of the procedure was eval uated by clinical improvement in pain, radiographic progression, and n eed for further surgery. All 5 stage I patients had substantial improv ement in pain, and only one showed X-ray progression. Five of the 6 (8 3%) stage II patients had improvement in pain, and 2 patients progress ed on X-ray Both stage III patients progressed on X-ray but one was cl inically improved. None of the 10 patients has required further surger y. Our results demonstrate that in early AVN, core decompression was b eneficial for almost all patients, even with progression on X-ray Core decompression should be considered in the management of SCD patients with early AVN. (C) 1996 Wiley-Liss, Inc.