Core Decompression For Treatment of Avascular Necrosis of Femoral Head In Children With Sickle Cell Anemia

Abstract

Sickle cell anemia (SCA) is a hereditary hemoglobin disorder that results in sickling of the red cell, leading to chronic hemolytic anemia, vascular occlusion and progressive organ damage. Avascular necrosis (AVN) is a known and common complication in sickle cell anemia. There are very little studies addressing core decompression of femoral neck in children with SCA. Many studies are done for adult patients. We did core decompression (CD) of femoral neck in children with AVN due to sickle cell anemia .39 hips in 29 patients are done between 2008 to 2018. The patients age ranges between 4 to 14 years of age. AVN is classified according to Ficat radiological classifications. Stage 1, 2A, and 2B are operated. Stage 3 and 4 hips were operated if the other hip is stage 1 or 2. We found a significant improvement of the operated patients compared to non-operated patients. Patients were assessed in follow-up in form of pain, gait, activity and radiological grading. Core decompression is done using a percutaneous cannulated drilling that do not cross the growth plate of the head. Excellent results were found in 87%, good results in 9% and poor results in 4%. We recommend doing core decompression in all grades of AVN in sickle cell anemia children. Conclusion Core decompression in children with sickle cell anemia is a new surgical intervention. It is a simple surgical procedure that can be done by most of pediatric orthopedic surgeons. We found that core decompression is an effective method to stop and improve clinical and radiological stages of AVN of femoral head in children sickle cell anemia. We found out that core decompression in children has far much better outcome compared to adult’s core decompression.