Abstract
Purpose
The aim of this study was to describe the clinical features of osteonecrosis (ON) in sickle cell disease (SCD) patients in Bahia, a Northeast state with the highest prevalence of the disease in Brazil.
Methods
Between 2006 and 2017, 283 cases of osteonecrosis in SCD patients were enrolled to analyse the age at diagnosis, genotype, gender, pain, distribution of the lesions and disease staging. MRI and radiograph were obtained at the participation.
Results
Of the 283 SCD cases, 120 (42.4%) were haemoglobin SS genotype while 163 (57.6%) were SC genotype. Two hundred and forty-six cases were bilateral and 37 were unilateral, with an average age at diagnosis of 33.7 (range 10–67) years. The most frequent identified ON site not only was the hip (74.6%), but also affected shoulder, knee and ankle. Most cases presented at early stage I (172, 60.8%) disease. No significant differences on the features of osteonecrosis were identified between haemoglobin SS and haemoglobin SC cases.
Conclusions
Given the relatively high prevalence of bilateral osteonecrosis at early stages, painful symptoms and rather late age at diagnosis, SCD patients should have radiological examination of their joints more often in order to prevent severe functional disability and increase patient’s life quality.
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Abbreviations
- HbS:
-
haemoglobin S
- MRI:
-
magnetic resonance imaging
- ON:
-
osteonecrosis
- SCD:
-
sickle cell disease
References
Aguilar C, Vichinsky E, Neumayr L (2005) Bone and joint disease in sickle cell disease. Hematol Oncol Clin North Am 19:929–941. https://doi.org/10.1016/j.hoc.2005.07.001
Adorno EV, Couto FD, Moura Neto JP, Menezes JF, Rego M, Reis MG et al (2005) Hemoglobinopathies in newborns from Salvador, Bahia, Northeast Brazil. Cad Saude Publica 21:292–298
Brasil, Ministério da Saúde, Secretaria de Atenção à Saúde (2012) Doença Falciforme: condutas básicas para o tratamento. Brasília: Ministério da Saúde. http://bvsms.saude.gov.br/bvs/publicacoes/doenca_falciforme_condutas_basicas.pdf. Accessed 28 February 2018
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 Joint Surg Am 88:2565–2572. https://doi.org/10.2106/JBJS.E.01455
Flouzat-Lachaniete CH, Roussignol X, Poignard A, Mukasa MM, Manicom O, Hernigou P (2009) Multifocal joint osteonecrosis in sickle cell disease. Open Orthop J 3:32–35. https://doi.org/10.2174/1874325000903010032
Hernigou P, Flouzat-Lachaniete CH, Daltro G, Galacteros F (2016) Talar osteonecrosis related to adult sickle cell disease: natural evolution from early to late stage. J Bone Joint Surg Am 98:1113–1121. https://doi.org/10.2106/JBJS.15.01074
Perfetti DC, Boylan MR, Naziri Q, Khanuja HS, Urban WP (2015) Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A nationwide database study. J Arthroplast 30:547–551. https://doi.org/10.1016/j.arth.2014.10.035
Hernigou P, Daltro G (2014) Osteonecrosis in sickle-cell disease. In: Koo K, Mont MA, Jones LC (eds) Osteonecrosis. Springer-Verlag, Berlin Heidelberg, pp 125–131. https://doi.org/10.1007/978-3-642-35767-1_16
Milner PF, Kraus AP, Sebes JI, Sleeper LA, Dukes KA, Embury SH et al (1991) Sickle cell disease as a cause of osteonecrosis of the femoral head. N Engl J Med 325:1476–1481. https://doi.org/10.1056/NEJM199111213252104
Marouf R, Gupta R, Haider MZ et al (2003) Avascular necrosis of the femoral head in adult Kuwaiti sickle cell disease patients. Acta Haematol 110:11–15. https://doi.org/10.1159/000072406
Mahadeo KM, Oyeku S, Taragin B, Rajpathak SN, Moody K, Santizo R, Driscoll MC (2011) Increased prevalence of osteonecrosis of the femoral head in children and adolescents with sickle-cell disease. Am J Hematol 86:806–808. https://doi.org/10.1002/ajh.22103
Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67:3–9
Mont MA, Tomek IM, Hungerford DS (1997) Core decompression for avascular necrosis of the distal femur: long term follow-up. Clin Orthop Relat Res 334:124-130
Cruess RL (1976) Steroid-induced avascular necrosis of the head of the humerus. Natural history and management. J Bone Joint Surg Br 58:313–317
Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77:34–41
Adesina O, Brunson A, Keegan THM, Wun T (2017) Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities and surgical outcomes in California. Blood Adv 1:1287–1295. https://doi.org/10.1182/bloodadvances.2017005256
Adekile AD, Gupta R, Yacoub F et al (2001) Avascular necrosis of the hip in children with sickle cell disease and high Hb F: magnetic resonance imaging findings and influence of a-thalassemia trait. Acta Haematol 105:27–31. https://doi.org/10.1159/000046529
Balogun RA, Obalum DC, Giwa SO, Adekoya-Cole TO et al (2010) Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria. J Orthop Surg Res 5:2. https://doi.org/10.1186/1749-799X-5-2
Sun W, Shi Z, Gao F, Wang B, Li Z (2016) The pathogenesis of multifocal osteonecrosis. Sci Rep 6:29576–29582. https://doi.org/10.1038/srep29576
LaPorte DM, Mont MA, Mohan V, Jones LC, Hungerford DS (1998) Multifocal osteonecrosis. J Rheumatol 25:1968–1974
Aleluia MM, Fonseca TCC, Souza RQ, Neves FI, da Guarda CC et al (2017) Comparative study of sickle cell anemia and hemoglobin SC disease: clinical characterization, laboratory biomarkers and genetic profiles. BMC Hematol 17:15. https://doi.org/10.1186/s12878-017-0087-7
Naessens V, Ward R, Kuo KHM (2017) A proposed treatment algorithm for adults with haemoglobin SC disease. Br J Haematol. https://doi.org/10.1111/bjh.14852
Mukisi-Mukaza M, Elbaz A, Samuel-Leborgne Y, Kéclard L, Le Turdu-Chicot C, Christophe-Duchange E, Mérault G (2000) Prevalence, clinical features, and risk factors of osteonecrosis of the femoral head among adults with sickle cell disease. Orthopedics 23:357–363
Baldwin C, Nolan VG, Wyszynski DF, Ma QL et al (2005) Association of klotho, bone morphogenic protein 6, and annexin A2 polymorphisms with sickle cell osteonecrosis. Blood 106:372–375. https://doi.org/10.1182/blood-2005-02-0548
Kato GJ, Steinberg MH, Gladwin MT (2017) Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest 127:750–760. https://doi.org/10.1172/JCI89741
Hauzeur JP, Malaise M, de Maertelaer V (2016) A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis. Int Orthop 40(7):1347–1351. https://doi.org/10.1007/s00264-015-3079-x
Funding
This work was supported by the Brazilian National Research Council (CNPq) and the Research Support Foundation of the State of Bahia (FAPESB).
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Contributions
GD, TBF and DAR were the surgeons who performed surgeries in this study. TBF, BAM and DAR assessed most of the clinical outcomes. GD and VF were responsible for conception, design, critical revision and analysis of the results. PBD assisted data collection. BAF drafted part of the manuscript. VF coordinated and made a major contribution to writing the manuscript. All authors read and approved the final manuscript.
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The Committee of Ethics in Research of the Climério de Oliveira Maternity Hospital (Federal University of Bahia, UFBA) approved this study, and informed consent was obtained in accordance with ethical principles and the Helsinki Declaration of 1975, and by the Brazilian resolution 196/96, of the Ministry of Health, Law 6638/79 and Normative Resolution 04/97.
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The authors declare that they have no competing interests.
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Daltro, G., Franco, B.A., Faleiro, T.B. et al. Osteonecrosis in sickle cell disease patients from Bahia, Brazil: a cross-sectional study. International Orthopaedics (SICOT) 42, 1527–1534 (2018). https://doi.org/10.1007/s00264-018-3905-z
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DOI: https://doi.org/10.1007/s00264-018-3905-z