Avascular Necrosis of Femoral Head in a 45 year Old Man: A Case Study of an Unnoticed Sickle Cell Disease Patient

Background: Periodic, self-limited episodes of excruciating musculoskeletal pain punctuate the lives of patients with Sickle Cell Disease (SCD) right from childhood. It is very rare for individuals with SCD to be asymptomatic from birth to adulthood. Objective: The purpose of this study was to present the case of a 45 year old man with an unnoticed sickle disease following Avascular Necrosis (AVN) of the femoral head. Case study: The patient is a 45 year old civil servant, who presented with complaints of pains of the right hip of six (6) months duration. He was involved in a Road Traffic Accident (RTA) one month prior to onset of pain, however no associated fractures was seen at that time. No history of prolonged exposure to steroids or radiation. He is not a known sickle cell disease patient and does not smoke cigarette nor ingest alcohol. Methodology and results: Physical examination revealed a well preserved man with no sickle cell disease habitus. Laboratory findings of FBC and ESR were normal. Plain radiographs of the pelvis and hips showed hypoplasia, sclerosis, articular marginal irregularity and subarticular cystic changes, all consistent with stage III (Ficat and Arlet). This prompted further evaluation of the patient to identify the cause of the AVN. The patient was then sent for genotyping; and a hemoglobin electrophoresis: (Hb SS+F) was noted. Conclusion: SCD can be diagnosed at adulthood for the first time due to asymptomatic presentation. Patient was therefore educated on the nature and progression of the disease and counseled for hemiarthroplasty of right hip. He was then placed on NSAIDS, reduced weight bearing on the hips and gradual range of motion exercises.