Avascular necrosis – SCiF 2013

Dr Marcus Bankes, Clinical Lead of the Department of Orthopaedics, Guy’s & St. Thomas’ Hospital NHS Foundation Trust

Avascular necrosis (AVN) and infection represent the majority of orthopaedic problems in Sickle Cell disease. Avascular necrosis can affect many parts of the skeleton but receives most attention when the femoral head is affected. This is because of the severe pain and disability which result from hip disease, but also due to the availability of effective surgical treatment, namely total hip replacement (THR). Aetiology, pathogenesis and classification of AVN will be presented as well as the key radiological features, particularly of femoralhead collapse. Whilst there have been improvements in the understanding anddetection of osteonecrosis, there are few treatments which seem to alter the natural history of the disease. However, with the advent of specialist centres, multidisciplinary care and advances in biomaterials, total hip replacement is no longer the unpredictable operation it once was and excellent results can now be obtained.

Identifying bone infection continues to be challenging but fortunately has become much easier in the era of MRI and, for the paediatric patients, ultrasound. Features of Sickle bone infection will be discussed as well as guidance for requesting surgical advice. Indications for surgery are few, but include biopsy and culture, drainage of abscesses, and sequestrectomy.

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