Core Decompression Surgery for Avascular Necrosis Can Delay Femoral Head Collapse in Patients with Sickle Cell Disease: A Case Report

Introduction Avascular necrosis (AVN) of the femoral head is a common orthopaedic complication in patients with sickle cell disease (SCD). By age 35, approximately half of patients homozygous for the sickle cell gene mutation have AVN, with involvement of both hips in 40-91% of patients. Without early intervention, the rate of femoral head collapse is high and often necessitates total hip arthroplasty (THA). Various treatment options exist for AVN, including physical therapy, pharmacotherapies, core decompression, and arthroplasty.the possibility has been raised that bone marrow containing osteogenic precursors implanted into a necrotic lesion of the femoral head may be of benefit in the treatment of this condition. For this reason, we studied the implantation of autologous bone-marrow mononuclear cells in a necrotic lesion of the femoral head to determine the effect on the clinical symptoms and the stage and volume of osteonecrosis.METHODS:We studied thirteen patients (eighteen hips However, outcomes of most treatments have been varied,and core decompression is a relatively safe and possibly effective option. To optimize core decompression further, we have tested a new technique involving thorough decompression of the osteonecrotic zone under endoscopic visualization (TDEV and as a result, there is no consensus on the best method to effectively prevent collapse and postpone the need for THA. Despite the lack of consensus, surgical core decompression has shown potential in the management of these cases. Core decompression with thorough debridement under endoscopic visualization followed by bone grafting and fixation with a nail/plate device produced encouraging results in a cohort of pediatric patients after a mean followup of 28 months, particularly for the treatment of lesions graded lower than Steinberg Stage IIIB.and core decompression is a relatively safe and possibly effective option. To optimize core decompression further, we have tested a new technique involving thorough decompression of the osteonecrotic zone under endoscopic visualization (TDEV Meanwhile, a recent Corresponding author: Lawrence Wells, MD Division of Orthopaedic Surgery The Children’s Hospital of Philadelphia 3401 Civic Center Blvd Philadelphia, PA 19104 [email protected] Afamefuna Nduaguba, BA Christine Goodbody, BA Wudbhav N. Sankar, MD Lawrence Wells, MD