Clinical and Radiological Severity of Avascular Necrosis of the Femoral Head in Sickle Cell Disease Patients.

Abstract

Background: Sickle cell disease (SCD) has a high prevalence in Sub-Saharan Africa. Avascular necrosis (AVN) of the femoral head is a devastating complication of SCD. Early presentation and diagnosis can be treated with hip-preserving procedures, resulting in good outcomes. Late presentations will require more complicated treatment procedures, such as hip replacement. A good knowledge of the clinical presentation and severity of the disease will aid in early detection and clinical management. This study was designed to establish the age and sex distribution, severity, and stages of AVN in SCD patients at Korle-Bu Teaching Hospital.

Materials and methods: This was a cross-sectional study of SCD patients referred to the orthopaedic clinic with AVN of the femoral head. An evaluation form was used to assess the patient's age, sex, genotype, and clinical symptoms. Hip X-rays were obtained to assess the severity of the disease. Chi-square tests were used to determine the association between demographic variables' data and AVN.

Results: Most patients were in the 31- to 50-year age group and presented with profound and limiting clinical features and advanced features on X-rays (stages 3 and 4 of the disease). There was a statistically significant association between the radiological stage of disease and clinical symptoms (limping, difficulty climbing stairs, and hip abduction).

Conclusion: The patients mostly presented with severe disease both clinically and radiologically and will require complex surgical procedures including hip arthroplasties. Clinicians at primary care centres need to look out for early signs so that they can refer them for treatment.