Comparing Two Articles on Osteonecrosis in Sickle Cell Disease

Abstract

This issue contains two articles on osteonecrosis of the femoral head in patients with sickle cell disease: “The Natural History of Asymptomatic Osteonecrosis of the Femoral Head in Adults with Sickle Cell Disease,” by Hernigou et al., and “Physical Therapy Alone Compared with Core Decompression and Physical Therapy for Femoral Head Osteonecrosis in Sickle Cell Disease: Results of a Multicenter Study at a Mean of Three Years After Treatment,” by Neumayr et al. Both are meaningful studies that add to our body of knowledge in the orthopaedic management of patients with sickle cell disease but appear to report strikingly different outcomes in similar patient populations. In the report by Hernigou et al., ninety-one (75%) of 121 patients required reconstructive surgery during the term of the study, with total hip replacement being performed in forty-two patients, valgus femoral osteotomy in twenty-three, and injection of cement into the femoral head in twenty-six. In comparison, in the study by Neumayr et al., only three (7.9%) of thirty-eight patients required reconstructive surgery in the form of total hip replacement. There are some similarities between the two studies, but several important differences may account for some of the variance in outcome. The two …