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Incidence and risk factors for osteonecrosis of the femoral head in five hundred and ten sickle cell disease paediatric patients

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Abstract

Purpose

Osteonecrosis of the femoral head (ONFH) is a degenerative and progressive disorder that mainly affects people with sickle cell disease (SCD). Herein, we aimed to search for a better understanding of markers that can act as risk factors for ONFH in patients with SCD.

Methods

We conducted a retrospective study including 510 SCD patients followed over 23 years. Patients were divided into the ONFH group and the no-ONHF control group. Univariate and multivariate logistic regression analyses were performed to identify risk factors.

Results

Among 510 SCD patients, 41(8%) were diagnosed with ONFH at a mean age of 167 months ± 64 (72–288). The cumulative incidence of ONHF increased from 2.3% at ten years to 18.3% at 20 years of age. The radiological grade 3 ONHF was predominant. No significant differences in sex, age at diagnosis of SCD, and Hb genotype were found between groups. The patient age and the time since diagnosis of SCD were statistically higher in patients with ONHF in univariate and multivariate analysis. ONHF was also associated with higher creatinine level (p = 0.001) lower LDH level (p = 0.006), and higher number of vaso-occlusive crisis (VOC)/patient/year (p < 0.001). The cumulative incidence of ONHF in patients having more than 3 VOC/year was significantly higher (43% versus 18.9% at 20 years, p < 0.001). In addition, infections, gallstones, growth delay, delayed initiation of hydroxyurea, and a higher transfusion rate were significantly associated with ONFH.

Conclusion

These findings confirm that ONFH is closely related to the age, severity, and duration of SCD. Better management of this disease prevents acute and chronic complications, and early screening of the ONFH as soon as the first signs of the severity of the disease are detected provides a better functional prognosis.

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Acknowledgments

We acknowledge all radiologists and orthopedists who have assisted with the diagnosis and management of patients.

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Authors and Affiliations

  1. Department of Pediatrics- Immunohematology and Stem Cell Transplantation, National Center of Bone Marrow Transplant, 02 Street Jbel Lakhdhar, Bab Saadoun, Tunis, Tunisia

    Monia Ouederni, Hatem Rouag, Ilhem Ben Fraj, Samia Rekaya, Ridha Kouki, Takwa Lamouchi, Ikram Zaiter, Fethi Mellouli, Mohamed Bejaoui & Monia Ben Khaled

  2. Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia

    Monia Ouederni, Ilhem Ben Fraj, Samia Rekaya, Takwa Lamouchi, Ikram Zaiter, Fethi Mellouli, Mohamed Bejaoui & Monia Ben Khaled

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  1. Monia Ouederni
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Contributions

Monia Ouederni and Hatem Rouag contributed to the the study design and conception, collected, analyzeed data, and wrote the paper. Monia Ben Khaled contributed to data collection. All authors read and approved the final manuscript.

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Correspondence to Monia Ouederni.

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Ouederni, M., Rouag, H., Ben Fraj, I. et al. Incidence and risk factors for osteonecrosis of the femoral head in five hundred and ten sickle cell disease paediatric patients. International Orthopaedics (SICOT) 47, 2941–2952 (2023). https://doi.org/10.1007/s00264-023-05886-8

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