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Peer-reviewedCC BY-NC 4.0Journal of Children's Orthopaedics

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

  • Rasim Abid Elayedatt1
  • Abhay Deodas Gahukamble1
  • Arul Murugan A1
  • Vikaas Ethanur Thuppale1
  • Aby Abraham2
  • Madhavi Kandagaddala3
  • Thomas Palocaren1
  1. 1Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India
  2. 2Department of Clinical Haematology, Christian Medical College, Vellore, India
  3. 3Department of Radiology, Christian Medical College, Vellore, India
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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.

Methods:: 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.

Results:: 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.

Conclusion:: 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.

Significance of Study:: Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.

Level of Evidence:: Level IV

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Cite

BibTeXRIS
BibTeX
@article{elayedatt2026retrospective,
  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}},
  author = {Rasim Abid Elayedatt and Abhay Deodas Gahukamble and Arul Murugan A and Vikaas Ethanur Thuppale and Aby Abraham and Madhavi Kandagaddala and Thomas Palocaren},
  journal = {Journal of Children's Orthopaedics},
  year = {2026},
  month = jul,
  doi = {10.1177/18632521261436299},
  url = {https://doi.org/10.1177/18632521261436299},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Rasim Abid Elayedatt
AU  - Abhay Deodas Gahukamble
AU  - Arul Murugan A
AU  - Vikaas Ethanur Thuppale
AU  - Aby Abraham
AU  - Madhavi Kandagaddala
AU  - Thomas Palocaren
PY  - 2026
DA  - 2026/07/15
JO  - Journal of Children's Orthopaedics
DO  - 10.1177/18632521261436299
UR  - https://doi.org/10.1177/18632521261436299
AB  - 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.  Methods:: 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.  Results:: 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.  Conclusion:: 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.  Significance of Study:: Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.  Level of Evidence:: Level IV
SN  - 1863-2521
SN  - 1863-2548
ER  -