{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:05:23Z","timestamp":1790787923976,"version":"4.1.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To evaluate the radiological outcomes of femoral head osteonecrosis (FHO) in children with sickle cell disease (SCD), comparing non-operative treatment (bisphosphonates) and head-preserving surgical interventions\u2014core decompression with bone marrow aspirate concentrate (CD-BMAC) and proximal femur reorientation osteotomy (PFRO)\u2014by analyzing changes in Steinberg stage before treatment to final follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective review of 28 hips from 17 pediatric SCD patients treated between 2010 and 2024, analyzed patient demographics, disease stage, treatment modalities, disease progression, and follow-up duration; and compared pre-collapse and post-collapse stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 75 hips with FHO in 51 children, 61 (81%) were non-traumatic. Of the 28 hips (13 pre-collapse, 15 post-collapse) in 17 children (mean age 11.6\u2009years; 58.8% male), the average interval from SCD diagnosis to FHO onset was 78.8\u2009months (Standard deviation-36.6). Treatments included bisphosphonates (11 hips), CD-BMAC (5), and PFRO (6). After excluding salvage procedures and lost follow-up, 20 hips were available for the final outcome analysis. At final follow-up (mean 30.7\u2009months), FHO improved or remained stable in 15 hips (75%), while it progressed by at least 1 Steinberg stage in 5 hips (25%). In pre-collapse hips, no further disease progression was seen. In post-collapse cases, progression was noted in three of five bisphosphonate-treated hips and two CD-BMAC-treated hips; PFRO-treated hips showed no progression. Two hips developed arthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Bisphosphonates, CD-BMAC, and PFRO prevent disease progression in pre-collapse hips. In post-collapse hips, PFRO showed no further progression, while CD-BMAC and bisphosphonates showed mixed results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance of Study:<\/jats:title>\n                    <jats:p>Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521261436299","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:26:47Z","timestamp":1784114807000},"page":"482-490","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective cohort study assessing radiological outcomes and risk factors for progression of femoral head osteonecrosis in children with sickle cell disease, following bisphosphonate therapy, CD-BMAC and proximal femoral reorientation osteotomy"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4703-0804","authenticated-orcid":false,"given":"Rasim Abid","family":"Elayedatt","sequence":"first","affiliation":[{"name":"Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-1848","authenticated-orcid":false,"given":"Abhay Deodas","family":"Gahukamble","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7990-6355","authenticated-orcid":false,"given":"Arul Murugan","family":"A","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8435-736X","authenticated-orcid":false,"given":"Vikaas Ethanur","family":"Thuppale","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aby","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-6997","authenticated-orcid":false,"given":"Madhavi","family":"Kandagaddala","sequence":"additional","affiliation":[{"name":"Department of Radiology, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6515-0929","authenticated-orcid":false,"given":"Thomas","family":"Palocaren","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGlobal-D-21-00176"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199503000-00018"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.143911"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.55275\/JPOSNA-2021-285"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.18.3262"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27503"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.77B6.7593098"},{"key":"e_1_3_3_9_2","first-page":"201","volume-title":"Osteonecrosis","author":"Steinberg DR","year":"2000","unstructured":"Steinberg DR, Steinberg ME. 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