title: Histopathology of aseptic necrosis of the femoral head in sickle cell disease.
abstract: This study compares the histopathology of bone biopsies from patients suffering from sickle cell anaemia (homozygote SS) to heterozygote patients (SA) and homozygotes with aseptic osteonecrosis (AA). The sensitivity to bacterial infection of sickle cell patients raises the question of the aetiology of sepsis in the onset of the necrosis. To our knowledge this study is the first to analyse the histopathology of osteonecrosis of the femoral head, at its early stages, in sickle cell anaemia. At the University Hospital of Pointe-à-Pitre, from 1994 to 2007, 38 bone biopsies were obtained from adult patients with avascular necrosis of the femoral head at the time of a core decompression procedure (SS, SC: 27; AS: 5; AA: 6). The histology of the biopsies confirmed the necrosis; all bacteriological cultures were negative. Patients displaying one S gene (SS, SC, AS) compared to homozygote subjects (AA) showed a significant increase of a nonspecific inflammatory granulomatosis (p = 0.003). No relationship was observed between the radiological stages and the histology whatever the genotype (p = 0.1). Inflammatory histopathology without sepsis or advanced alteration characterises the early stages of sickle cell necrosis. This inflammatory process is absent in idiopathic avascular necrosis.
authors.affiliation: Service d'Orthopédie Traumatologie, CHU de Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Mukisi-Mukaza
authors.forename: Anne
authors.initials: A
authors.lastname: Gomez-Brouchet
authors.forename: Monique
authors.initials: M
authors.lastname: Donkerwolcke
authors.forename: Maurice
authors.initials: M
authors.lastname: Hinsenkamp
authors.forename: Franz
authors.initials: F
authors.lastname: Burny
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000235:genetics / Q000473:pathology*; D001706:Biopsy; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology*; D005271:Femur Head Necrosis / Q000209:etiology / Q000235:genetics / Q000473:pathology*; D005838:Genotype; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000235:genetics / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult