Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 5, pp 609–613 | Cite as

Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients

Orthopaedic Surgery



Sickle cell disease (SCD) is the most common cause of avascular necrosis of femoral head (ANFH) in childhood. Advances in medical treatment led to improved life expectancy of such patients. SCD-related ANFH frequently progress to total collapse of the femoral head necessitating hip replacement. However, SCD patient are at more risk of intra- and post-operative complications and suboptimal outcome of total hip arthroplasty. Hence, it is imperative to preserve the femoral head as long as possible.

Patients and methods

Between September 1992 and June 2007, 94 core decompression procedures were done to SCD patients who had modified Ficat stage I, IIA and IIB ANFH. Sixty one patients underwent a classical 8-mm drilling and 33 patients underwent 3.2-mm diameter MD technique. Patients were followed up for minimum of 2 years and were evaluated for clinical and Harris Hip Score improvement and for radiological progression.


All 19 hips that had Ficat stage I had significant reduction of pain and improvement of Harris Hip Score. No patient has required further surgery. Among the 39 hips with Ficat IIA at time of procedure, 80 % of hips which underwent CD and 78 % of MD cases had significant reduction of pain and improvement of HHS. Those patients showed no radiographic progression of the disease. The remaining, 20 % CD and 22 % MD eventually progressed radiologically to grade III or grade IV and had HHS less than 75 at last visit. In the 36 cases with Ficat IIB, 52 % CD and 52.8 % MC had significant reduction of pain and improvement of HHS. The rest showed no improvement in pain and function, and progressed to stage IV; 11 of them underwent THA and one patient refused surgery.


While multiple drilling is safer and less invasive than single coring in SCD, there is no statistically significant difference in outcome or complication rate between both procedures done for ANFH in patients with SCD.


Core decompression Multiple drilling Avascular necrosis Sickle cell disease 



I would like to thank Dr. Adel Yusuf (Biostatician) who helped me a lot in statistical analysis of the results.


  1. 1.
    Styles LA, Vichinsky EP (1996) Core decompression in avascular necrosis of the hip in sickle-cell disease. Am J Hematol 52(2):103–107PubMedCrossRefGoogle Scholar
  2. 2.
    Hernigou P, Galacteros F, Bachir D, Goutallier D (1991) Deformities of the hip in adults who have sickle-cell disease and had avascular necrosis in childhood. A natural history of fifty-two patients. J Bone Jt Surg Am 73(1):81–92Google Scholar
  3. 3.
    Cheng EY, Thongtrangan I, Laorr A, Saleh KJ (2004) Spontaneous resolution of osteonecrosis of the femoral head. J Bone Jt Surg Am 86-A(12):2594–2599Google Scholar
  4. 4.
    Hernigou P, Bachir D, Galacteros F (2003) The natural history of symptomatic osteonecrosis in adults with sickle-cell disease. J Bone Joint Surg Am 85-A(3):500–504PubMedGoogle Scholar
  5. 5.
    Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67(1):3–9PubMedGoogle Scholar
  6. 6.
    Jeong GK, Ruchelsman DE, Jazrawi LM, Jaffe WL (2005) Total hip arthroplasty in sickle cell hemoglobinopathies. J Am Acad Orthop Surg 13(3):208–217PubMedGoogle Scholar
  7. 7.
    Acurio MT, Friedman RJ (1992) Hip arthroplasty in patients with sickle-cell haemoglobinopathy. J Bone Joint Surg Br 74(3):367–371PubMedGoogle Scholar
  8. 8.
    Moran MC, Huo MH, Garvin KL, Pellicci PM, Salvati EA (1993) Total hip arthroplasty in sickle cell hemoglobinopathy. Clin Orthop Relat Res 294:140–148PubMedGoogle Scholar
  9. 9.
    Clarke HJ, Jinnah RH, Brooker AF, Michaelson JD (1989) Total replacement of the hip for avascular necrosis in sickle cell disease. J Bone Jt Surg Br 71(3):465–470Google Scholar
  10. 10.
    Hickman JM, Lachiewicz PF (1997) Results and complications of total hip arthroplasties in patients with sickle-cell hemoglobinopathies. Role of cementless components. J Arthroplasty 12(4):420–425PubMedCrossRefGoogle Scholar
  11. 11.
    Hernigou P, Habibi A, Bachir D, Galacteros F (2006) The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease. J Bone Jt Surg Am 88(12):2565–2572CrossRefGoogle Scholar
  12. 12.
    Song WS, Yoo JJ, Kim YM, Kim HJ (2007) Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res 454:139–146PubMedCrossRefGoogle Scholar
  13. 13.
    Mont MA, Ragland PS, Etienne G (2004) Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res (429):131–138Google Scholar
  14. 14.
    Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA (2008) Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res 466(5):1093–1103PubMedCrossRefGoogle Scholar
  15. 15.
    Smith SW, Fehring TK, Griffin WL, Beaver WB (1995) Core decompression of the osteonecrotic femoral head. J Bone Jt Surg Am 77(5):674–680Google Scholar
  16. 16.
    Lavernia CJ, Sierra RJ (2000) Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty 15(2):171–178PubMedCrossRefGoogle Scholar
  17. 17.
    Mukisi MM, Bashoun K, Burny F (2009) Sickle-cell hip necrosis and intraosseous pressure. Orthop Traumatol Surg Res 95(2):134–138PubMedCrossRefGoogle Scholar
  18. 18.
    Mont MA, Carbone JJ, Fairbank AC (1996) Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res (324):169–178Google Scholar
  19. 19.
    Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K (1991) Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res (268):140–151Google Scholar
  20. 20.
    Floerkemeier T, Lutz A, Nackenhorst U, Thorey F, Waizy H, Windhagen H, von Lewinski G (2011) Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis. Int Orthop 35(10):1461–1466. doi: 10.1007/s00264-010-1138-x PubMedCrossRefGoogle Scholar
  21. 21.
    Gong SY, Kim HW, Park HW, Lee SY, Lee KS (2011) Effects of multiple drilling on the ischemic capital femoral epiphysis of immature piglets. Yonsei Med J 52(5):809–817PubMedCrossRefGoogle Scholar
  22. 22.
    Shimizu K, Moriya H, Akita T, Sakamoto M, Suguro T (1994) Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head. J Bone Jt Surg Am 76(2):215–223Google Scholar
  23. 23.
    Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM (1999) Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res (367):262–271Google Scholar
  24. 24.
    Hungerford DS, Jones LC (2008) Core decompression. Tech Orthop 23(1):26–34CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.College of MedicineUniversity of DammamDammamSaudi Arabia

Personalised recommendations