ABSTRACT
Avascular necrosis of bone is a severe complication of sickle cell disease (SCD) and Management of these problems is often difficult because of the diagnostic imprecision of most laboratory and imaging investigations and because of the lack of evidence for most surgical procedures in sickle cell disease. Its treatment is not standardized. The objective in this case is to determine the impact of core decompression and PRP infusion in the management of Avascular necrosis of hip. In this case, a young Indian male with a known history of sickle cell disease presented to the clinic with severe bilateral hip pain. The pain had lasted for several months and had not improved with anti- inflammatory medication and starting on alandronate. There was severe pain with internal and external rotation of the hip. MRI of the femur showed stage 2 or 3 avascular necrosis of the femoral head, while X-rays of the femur were unremarkable. Patient managed conservatively by Non weight- bearing for several weeks and oral medication shortly thereafter, the patient underwent core decompression of the bilateral femoral head as well as continuing on Alendronate, a bisphosphonate. The patient improved temporarily but regressed shortly thereafter. His avascular necrosis worsened radiographically over the next several months. At this point, the only other option would be to do a total hip arthroplasty, but the patient may need several more throughout his lifetime due to the lifespan of the artificial replacement. There have only been scarce reports of avascular necrosis in patients with sickle cell trait. This manuscript presents such a case and includes the trials and tribulations associated with its management.