Hip Osteonecrosis in Sickle Cell Disease Patient With Severe Central Head Collapse Treated With Staged Hip Preservation

Case: An 11-year-old boy with hemoglobin SC sickle cell disease (SCD) presented with progressive left hip pain, limited range of motion, and chronic gait abnormality. Imaging revealed bilateral osteonecrosis with severe central collapse and lateral extrusion of the left femoral head. He underwent staged hip preservation: examination under anesthesia, adductor tenotomy, femoral head elevation with trephine decompression and cancellous autograft and allograft, followed by femoral varus osteotomy (FVO) and anterior osteochondroplasty. At the 2-year follow-up, pain, gait, mobility, and hip motion markedly improved with maintained femoral head containment. Conclusion: Femoral head elevation combined with FVO may improve symptoms and delay arthroplasty in advanced pediatric SCD hip osteonecrosis.