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Risk factors for osteonecrosis of the femoral head in patients with sickle cell disease

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Abstract

The mechanisms involved in the pathogenesis of osteonecrosis of the femoral head in sickle cell disease are not fully known. The aim of this study was to identify risk factors for osteonecrosis of the femoral head among sickle cell disease patients. Clinical (frequency of painful crises and hospitalisation) and laboratory parameters (euglobulin clot lysis time, haematocrit, platelet count, and leucocyte count) of 25 consecutive patients with avascular necrosis of the femoral head from sickle cell disease were compared with those of 26 age- and sex-matched sickle cell disease patients without avascular necrosis. The group with avascular necrosis of the femoral head (mean age 23.7±4.9 years) had a significantly higher rate of painful crises (p = 0.03) and hospitalisations per year (p = 0.002) than the group without avascular necrosis (mean age 21.6±5.2 years). The group with avascular necrosis also had a significantly higher euglobulin clot lysis time than the group without avascular necrosis (p = 0.001). In conclusion, it appears that not all patients with sickle cell disease have impaired fibrinolytic activity. The aetiology of avascular necrosis in sickle cell disease is multifactorial.

Résumé

Les mécanismes de la nécrose de la tête fémorale dans la drépanocytose sont encore relativement obscures. Le but de cette étude est de mettre en évidence les facteurs de risque de la tête fémorale chez les patients présentant une drépanocytose. Matériel et méthode : l’évaluation des paramètres cliniques (fréquence des crises, nombre d’hospitalisations) et biologique (lyse du caillot, euglobuline, hématrocrite, plaquettes et numération leucocytaire) de 25 patients consécutifs présentant une nécrose avasculaire de la tête fémorale dans le cadre d’une drépanocytose ont été comparés aux données d’une série de patients âgés en moyenne de 26 ans et présentant une drépanocytose sans nécrose aseptique. Résultats : le groupe des nécroses aseptiques de tête fémorale était âgé en moyenne de 23,7 ± 4,9 avec un nombre de crises douloureuses significativement plus élevé (p = 0,03) et un nombre d’hospitalisation également plus élevé (p = 0,002) que dans le groupe des nécroses avasculaires simples, moyenne d’âge 21,6 ± 5,2 ans. Le groupe présentant une nécrose avasculaire présentant également un taux de lyse du caillot et d’euglobuline plus élevé que dans le groupe sans nécrose (p = 0,001). Conclusion : il semble que les patients porteurs d’une drépanocytose comportent sur le plan biologique une activité fribrinolytique plus importante. L’étiologie de la nécrose avasculaire dans le cadre de la drépanocytose est multifactorielle.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

    A. L. Akinyoola

  2. Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

    I. A. Adediran & A. R. Bolarinwa

  3. Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

    C. M. Asaleye

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  1. A. L. Akinyoola
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  2. I. A. Adediran
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  3. C. M. Asaleye
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  4. A. R. Bolarinwa
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Correspondence to A. L. Akinyoola.

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Akinyoola, A.L., Adediran, I.A., Asaleye, C.M. et al. Risk factors for osteonecrosis of the femoral head in patients with sickle cell disease. International Orthopaedics (SICOT) 33, 923–926 (2009). https://doi.org/10.1007/s00264-008-0584-1

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  • DOI: https://doi.org/10.1007/s00264-008-0584-1

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