{
  "abstract": "Aim:: To evaluate the radiological outcomes of femoral head osteonecrosis (FHO) in children with sickle cell disease (SCD), comparing non-operative treatment (bisphosphonates) and head-preserving surgical interventions—core decompression with bone marrow aspirate concentrate (CD-BMAC) and proximal femur reorientation osteotomy (PFRO)—by analyzing changes in Steinberg stage before treatment to final follow-up.\n\nMethods:: Retrospective review of 28 hips from 17 pediatric SCD patients treated between 2010 and 2024, analyzed patient demographics, disease stage, treatment modalities, disease progression, and follow-up duration; and compared pre-collapse and post-collapse stages.\n\nResults:: Among 75 hips with FHO in 51 children, 61 (81%) were non-traumatic. Of the 28 hips (13 pre-collapse, 15 post-collapse) in 17 children (mean age 11.6 years; 58.8% male), the average interval from SCD diagnosis to FHO onset was 78.8 months (Standard deviation-36.6). Treatments included bisphosphonates (11 hips), CD-BMAC (5), and PFRO (6). After excluding salvage procedures and lost follow-up, 20 hips were available for the final outcome analysis. At final follow-up (mean 30.7 months), FHO improved or remained stable in 15 hips (75%), while it progressed by at least 1 Steinberg stage in 5 hips (25%). In pre-collapse hips, no further disease progression was seen. In post-collapse cases, progression was noted in three of five bisphosphonate-treated hips and two CD-BMAC-treated hips; PFRO-treated hips showed no progression. Two hips developed arthritis.\n\nConclusion:: Bisphosphonates, CD-BMAC, and PFRO prevent disease progression in pre-collapse hips. In post-collapse hips, PFRO showed no further progression, while CD-BMAC and bisphosphonates showed mixed results.\n\nSignificance of Study:: Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.\n\nLevel of Evidence:: Level IV",
  "abstract_shown": true,
  "affiliations": [
    "Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India",
    "Department of Clinical Haematology, Christian Medical College, Vellore, India",
    "Department of Radiology, Christian Medical College, Vellore, India"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rasim Abid Elayedatt",
      "orcid": "0009-0007-4703-0804"
    },
    {
      "affs": [
        0
      ],
      "name": "Abhay Deodas Gahukamble",
      "orcid": "0000-0002-1557-1848"
    },
    {
      "affs": [
        0
      ],
      "name": "Arul Murugan A",
      "orcid": "0000-0001-7990-6355"
    },
    {
      "affs": [
        0
      ],
      "name": "Vikaas Ethanur Thuppale",
      "orcid": "0000-0002-8435-736X"
    },
    {
      "affs": [
        1
      ],
      "name": "Aby Abraham"
    },
    {
      "affs": [
        2
      ],
      "name": "Madhavi Kandagaddala",
      "orcid": "0000-0002-1895-6997"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas Palocaren",
      "orcid": "0000-0002-6515-0929"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5v0x260k0anp9.bib",
  "cited_by": 0,
  "doi": "10.1177/18632521261436299",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13372798/",
  "id": "5v0x260k0anp9",
  "issns": [
    "1863-2521",
    "1863-2548"
  ],
  "landing_url": "https://doi.org/10.1177/18632521261436299",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Hip disorders"
    ],
    [
      "heading",
      "Original Clinical Articles"
    ],
    [
      "openalex",
      "2732|Bone and Joint Diseases"
    ]
  ],
  "openalex": "W7168385626",
  "pdf_url": null,
  "pmcid": "PMC13372798",
  "pmid": "42465526",
  "published": "2026-07-15",
  "publisher": "SAGE Publications",
  "ris": "https://research.draconitic.com/paper/5v0x260k0anp9.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T12:22:33Z",
      "native_id": "PMC13372798",
      "source": "pmc",
      "url": "https://doi.org/10.1177/18632521261436299"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2732|Bone and Joint Diseases",
      "subfield": "surgery"
    }
  ],
  "title": "Retrospective cohort study assessing radiological outcomes and risk factors for progression of femoral head osteonecrosis in children with sickle cell disease, following bisphosphonate therapy, CD-BMAC and proximal femoral reorientation osteotomy",
  "title_text": "Retrospective cohort study assessing radiological outcomes and risk factors for progression of femoral head osteonecrosis in children with sickle cell disease, following bisphosphonate therapy, CD-BMAC and proximal femoral reorientation osteotomy",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T12:20:15Z",
  "url": "https://research.draconitic.com/paper/5v0x260k0anp9",
  "venue": "Journal of Children's Orthopaedics",
  "versions": []
}