Association and Risk Factors of Osteonecrosis of Femoral Head in Sickle Cell Disease: A Systematic Review

Leandro, Márcio Passos; Sá, Cloud Kennedy Couto de; Filho, Diógenes Pires Serra; Souza, Lucas Azevedo Alves De; Salles, Cristina; Tenório, Mário César Carvalho; Paz, Cláudio Luiz da Silva Lima; Matos, Marcos Almeida

doi:10.1007/s43465-021-00469-4

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…Those who had been transfused more than three times since birth also had a higher risk of developing AOFH. Frequent VOC remains the most consistent comorbidity of AOFH [14,15,[16][17][18]. It is well known that the pain rate is a measure of clinical severity in sickle cell disease.…”

Section: Discussionmentioning

confidence: 99%

“…Low foetal haemoglobin levels and high haematocrit levels are associated with increased intravascular sickling and high viscosity, predisposing to AOFH [19]. In a systematic review, Leandro showed that among multiple clinical factors which have been studied as possible markers associated with AOFH, the severity of the disease appears to be the most important risk factor to be considered including manifestations such as the number of acute chest syndrome, pain crisis, hospitalizations or even limb ulcers [15]. A longitudinal prospective study of AOFH incidence and progression conducted in a cohort of 30 pediatric subjects with sickle cell anemia from Kuwait showed that participants with progressive AOFH had frequent VOCs [20].…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors of avascular Osteonecrosis of the Femoral Head in Children at the National Reference Center for Sickle Cell Disease in Brazzaville, Congo

Atipo-Tsiba

Bilongo-Bouyou

Bango³

et al. 2023

IBRR

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Introduction: The avascular osteonecrosis of the femoral head (AOFH) is a common complication of sickle cell disease (SCD). It exposes to lameness and sometimes to a very debilitating handicap. It is a source of desocialization, particularly in developing countries where prosthetic surgery remains inaccessible to the majority. This survey aimed to identify the risk of occurence AOFH. Materials and Methods: It was a case-control study carried between october 2017 and september 2021 at the National Reference Center for SCD « Antoinette Sassou Nguesso » in Brazzaville. It concerned 31 children with clinical and radiographic signs of AOFH. Clinical (age at diagnosis of SCD, frequency of vasoocclusive crises and hospitalization for vasoocclusive crises, number of blood transfusion) as well as hematological examination (blood count in the intercritical period) and hydroxyurea treatment were compared with those of 62 children with no clinical and radiographic signs of AOFH. The chi2 statistical test and the odds ratio were used for the comparison (P ˂ 0.05). Results: The sex ratio was 1.38 versus 0.93 (p = 0.50). The mean age of diagnostic of SCD was 3.76 ± 2.56 years versus 3.94 ± 2.01 years (p = 0.81). Logistic regression showed that SCD children with AOFH had a significantly higher rate of annual frequency of VOC (4.16 ± 1.18 vs 2.91 ± 1.68; P = 0.015), annual frequency of hospitalization for VOC (3.74±1.65 vs 1.45 ± 1.28; P = 0.000) and number of blood transfusions (3.38 ± 2.69 vs 2.42 ± 2.32; P = 0.03). Conclusion: Emphasis should be placed on the prevention and early management of acute complications of SCD. The role of hydroxyurea should be clarified by further work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors of avascular Osteonecrosis of the Femoral Head in Children at the National Reference Center for Sickle Cell Disease in Brazzaville, Congo

Atipo-Tsiba

Bilongo-Bouyou

Bango³

et al. 2023

IBRR

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“…Blood flow is compromised, increasing the risk of multifocal lesions, leading to long‐term disability, chronic pain, and bone fractures. The incidence of AVN increases with age, progressing from initial uniform oedema of bone marrow to areas with frank signals of infarcts or degenerative and sclerotic tissue 15,17 . The head of the femur is mainly involved in this pathological process, and, to the best of our knowledge, very few studies explore other skeletal segments in SCD children 5,21,22 .…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of AVN increases with age, progressing from initial uniform oedema of bone marrow to areas with frank signals of infarcts or degenerative and sclerotic tissue. 15,17 The head of the femur is mainly involved in this pathological process, and, to the best of our knowledge, very few studies explore other skeletal segments in SCD children. 5,21,22 For this reason, we had to use a classification of AVNs that is based only on observations made at the hip and femoral head.…”

Section: Discussionmentioning

confidence: 99%

“…Hands, feet, forearms, and distal legs were excluded to avoid long acquisition sessions. All abnormal MRI findings were considered in the study: the diagnosis of lesions ranged from areas of diffuse hyperintense signal described as uniform edema to abnormal band‐like signals and hypo‐intense band‐like zones on T1‐weighted images, which match hyper‐intense zones STIR images according to the classification of bone infarcts and lesions described elsewhere 12,15–18 …”

Section: Methodsmentioning

confidence: 99%

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Occult ischemic bone lesions in children with sickle cell disease: A study of prevalence

Voi

Turrini

Mattavelli

et al. 2022

European J of Haematology

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Introduction Avascular necrosis (AVN) is a severe complication of sickle cell disease (SCD) and involves principally the femoral head. Few data exist about the prevalence of lesions in other segments. Methods In this cross‐sectional study, 42 children (20 males and 22 females) underwent a magnetic resonance imaging (MRI) of the spine, upper arms, and femurs. The primary outcome was to define the prevalence and locations of bone infarcts. Results Forty‐two patients completed the study; the total median age was 11.9 years (interquartile range = 9.5–13.9). Eleven patients (26.2%) were positive for altered bone findings for a total of 32 lesions. Most of the lesions were in the humerus 17 (53.1%), 11 (34.4%) in the femurs, and 4 (12.5%) in the vertebrae. The median number of vaso‐occlusive crises (VOCs) was two and four for patients without and with bone lesions, respectively (p = .01). The annual rate of VOC is the best marker for the positive MRI (odds ratio = 82.6; p = .03), and it is correlated with the number of sites involved (p = .02). Conclusions Our study highlights that the prevalence of skeletal lesions could be underestimated, and it provides the basis for clinical reasoning and tailored therapy in SCD children.

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

Ouederni

Hatem²,

Fraj

et al. 2023

International Orthopaedics (SICOT)

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Association and Risk Factors of Osteonecrosis of Femoral Head in Sickle Cell Disease: A Systematic Review

Cited by 7 publications

References 23 publications

Risk Factors of avascular Osteonecrosis of the Femoral Head in Children at the National Reference Center for Sickle Cell Disease in Brazzaville, Congo

Risk Factors of avascular Osteonecrosis of the Femoral Head in Children at the National Reference Center for Sickle Cell Disease in Brazzaville, Congo

Occult ischemic bone lesions in children with sickle cell disease: A study of prevalence

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

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