Background: Osteonecrosis of the femoral head is a common
complication in patients with sickle cell disease, and collapse of the femoral
head occurs in 90% of patients within five years after the diagnosis of the
osteonecrosis. However, the efficacy of hip core decompression to prevent the
progression of osteonecrosis in these patients is still controversial.
Methods: In a prospective multicenter study, we evaluated the safety
of hip core decompression and compared the results of decompression and
physical therapy with those of physical therapy alone for the treatment of
osteonecrosis of the femoral head in patients with sickle cell disease.
Forty-six patients (forty-six hips) with sickle cell disease and Steinberg
Stage-I, II, or III osteonecrosis of the femoral head were randomized to one
of two treatment arms: (1) hip core decompression followed by a physical
therapy program or (2) a physical therapy program alone. Eight patients
withdrew from the study, leaving thirty-eight who participated.
Results: Seventeen patients (seventeen hips) underwent decompression
combined with physical therapy, and no intraoperative or immediate
postoperative complications occurred. Twenty-one patients (twenty-one hips)
were treated with physical therapy alone. After a mean of three years, the hip
survival rate was 82% in the group treated with decompression and physical
therapy and 86% in the group treated with physical therapy alone. According to
a modification of the Harris hip score, the mean clinical improvement was 18.1
points for the patients treated with hip core decompression and physical
therapy compared with 15.7 points for those treated with physical therapy
alone. With the numbers studied, the differences were not significant.
Conclusions: In this randomized prospective study, physical therapy
alone appeared to be as effective as hip core decompression followed by
physical therapy in improving hip function and postponing the need for
additional surgical intervention at a mean of three years after treatment.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.