Prevalence, clinical features, and risk factors of osteonecrosis of the femoral head among adults with sickle cell disease

This prospective study examined the prevalence, clinical features, and risk factors of osteonecrosis of the femoral head among adult sickle cell disea se patients in Guadeloupe. Screening of osteonecrosis of the femoral head w as performed using radiography, bone scintigraphy, and tomodensitometry. On e hundred thirteen adults with sickle cell disease (67 SS and 46 SC patient s) comprised the study population, Forty-two (37.2%) patients had osteonecr osis of one or both hips (67 [29.6%] hips) without association to a particu lar genotype, although bilateral involvement was more frequent among SS pat ients. While the prevalence of femoral head osteonecrosis increased with ag e, patients of all ages were affected, particularly young SC adults. Osteon ecrosis of the femoral head was diagnosed at preradiographic stages (stage I) in 30% of hips and was frequently asymptomatic (60% of all cases; 95% an d 90% of stages I and II, respectively). Osteonecrosis of the femoral head was significantly associated with a history of leg ulcer and osteonecrosis of the humeral head. SS patients with higher hemoglobin levels had an incre ased risk of osteonecrosis of the femoral head.