title: Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment.
abstract: 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.
authors.affiliation: Department of Hematology, Children's Hospital and Research Center, 747 52nd Street, Oakland, CA 94609, and Department of Orthopaedic Surgery, University of California, San Francisco 94143, USA. lneumayr@mail.cho.org
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Neumayr
authors.forename: Christine
authors.initials: C
authors.lastname: Aguilar
authors.forename: Ann N
authors.initials: AN
authors.lastname: Earles
authors.forename: Harry E
authors.initials: HE
authors.lastname: Jergesen
authors.forename: Charles M
authors.initials: CM
authors.lastname: Haberkern
authors.forename: Bamidele F
authors.initials: BF
authors.lastname: Kammen
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nancarrow
authors.forename: Eric
authors.initials: E
authors.lastname: Padua
authors.forename: Meredith
authors.initials: M
authors.lastname: Milet
authors.forename: Bernard N
authors.initials: BN
authors.lastname: Stulberg
authors.forename: Roger A
authors.initials: RA
authors.lastname: Williams
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Orringer
authors.forename: Nora
authors.initials: N
authors.lastname: Graber
authors.forename: Shanda M
authors.initials: SM
authors.lastname: Robertson
authors.forename: Elliott P
authors.initials: EP
authors.lastname: Vichinsky
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D019644:Arthroplasty, Replacement, Hip; D003131:Combined Modality Therapy; D015897:Comorbidity; D019299:Decompression, Surgical; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D005272:Femur Neck / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing