gms | German Medical Science

Objectives: King's College Hospital is situated in South London and treats a large number of patients suffering from sickle cell disease. The musculo-skeletal involvement is treated in a multi-disciplinary clinic involving haematologists and orthopaedic surgeons.

We present our prospective case series of patients with sickle cell disease and musculoskeletal osteonecrosis.

Methods: The prospective case series will be reported using validated outcome scores for hip, shoulder and knee. Results of imaging - plain radigraphs and MRI will be reported using the ARCO classification, where possible with reference to the proposed new classification.

Results and Conclusion: Forty patients have been reviewed. The age range is 22 - 63 years (mean 39). The hip joint is involved in 32 patients, of these 16 bilateral. Treatment includes 4 core decompressions and 12 total hip replacements. The shoulder has been affected in 23 patients, in 9 patients bilateral. In 4 patients the shoulder has been the only musculoskeletal involvement. Treatment has included 2 hemi-arthroplasties and 2 arthroscopic procedures. In 5 patients the knee has been affected and one patient is awaiting a total knee replacement.

Most patients suffer from 2-5 sickle cell crisis episodes per year some up to 15-20.

The main stay of treatment is haematological. The natural history, progression of disease and current outcome of treatment indicates that progression and multi-system involvement depends very much on disease activity, but not always. Risk factors and indication for early surgical intervention will be highlighted.