Results of core decompression with biological and pharmacological augmentation in osteonecrosis of femoral head in sickle cell positive young adults

Introduction: Osteonecrosis of Femoral head (ONFH) is a common and serious complication of sickle cell disease (SCD). Without early treatment intervention, incidence of femoral head collapse and secondary osteoarthritis is very high and occur early in these patients. Aim of this study is to relieve the symptoms, improve the functional outcomes for better activity of daily life (ADL) and delay the progression of head collapse. Materials and Methods: In this prospective study, 32 hips in 20 pts were selected by exclusion and inclusion criteria. All selected cases were belonging to stage I, II and III according to modified Ficat and Arlet classification. Mean age of presentation was 25 years. We did core decompression by making two core tracks of 6 mm diameter each. Biological and pharmacological augmentation was done in the form of autologous cancellous bone graft (ACBG) and oral Alendronate respectively. Percutaneous adductor tenotomy was done in stage IIB and III. Functional and Radiological assessment was done by Harris Hip Score (HHS) and serial X-rays and MRI respectively. Follow up was done up to 96 weeks. Results and Discussion: Average operative time, blood loss and hospital stay were 50 minutes, 40 ml, 7.5 days. Infection rate was only 6.25%. We observed 31.25% excellent, 43.75% good, 12.50% fair and 12.50% poor outcomes. Mean postoperative and preoperative HSS was 83 and 65 respectively. Conclusion: We concluded that this technique is a relatively safe, cost effective, simple to perform, has very low complication rate and an effective treatment option for the younger patients.