Osteonecrosis of the femoral head among adult patients with sickle-cell disease in Guadeloupe: prevalence, clinical features and risk factors

ABSTRACT

Osteonecrosis of the femoral head (ONFH) is a frequent complication of sickle-cell disease (SCD). We conducted systematic screening of ONFH by using the association of radiography, bone scintigraphy and tomodensitometry. This paper presents our first results concerning 113 adult patients (67 SS, 46 SC), prevalence, clinical features, risk factors, and association with other SCD complications. Forty-two patients (37.2 percent) were found to have osteonecrosis of one or both hips (67 hips, 29.6 percent) without association to a particular genotype, although bilateral involvement was considerably more frequent among SS patients. ONFH affected patients of all ages and in particular SC young adult patients were found to be affected frequently. ONFH was diagnosed at pre-radiological stages (Stage 1) for 31.3 percent of hips and was frequently aysmptomatic (60 percent of all cases, 95 and 90 percent of Stages I and II, respectively), indicating need for systematic screening when early diagnosis is desired. For SS patients, ONFH was more frequent when follow-up began later. ONFH was also associated with higher parity and history of leg ulcer for both genotypes. No correlation was found with biological data, in particular haematological variables, except for high glucose levels for SS patients. We have initiated a prospective study of ONFH among patients followed at the SCD Centre of Guadeloupe, with special concern in diagnosis at pre-radiological stages, and outcome of patients. Further data will be provided by longitudinal follow-up of adult patients as well as inclusion of children followed from birth after neonatal screening (AU)