{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:20:46Z","timestamp":1790796046100,"version":"4.1.0"},"reference-count":41,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Osteonecrosis, a form of ischemic bone injury that leads to degenerative joint disease, affects \u223c30% of people with sickle cell disease. Although osteonecrosis most commonly affects the femoral head (often bilaterally, with asymmetric clinical and radiographic progression), many people with sickle cell disease also present with multifocal joint involvement. We present the case of a young woman with bilateral osteonecrosis of the femoral head at varying stages of progression; we also highlight other important comorbid complications (eg, chronic pain requiring long-term opioids, debility, and social isolation) and postoperative outcomes. In this review, partly based on recommendations on osteonecrosis management from the 2014 evidence-based report on sickle cell disease from the National Heart, Lung and Blood Institutes, we also discuss early signs or symptoms of osteonecrosis of the femoral head, radiographic diagnosis and staging criteria, hydroxyurea effect on progression to femoral head collapse, and surgical outcomes of total hip arthroplasty in the modern era. In summary, we failed to find an association between hydroxyurea use and femoral head osteonecrosis; we also showed that evidence-based perioperative sickle cell disease management resulted in superior postoperative outcomes after cementless total hip arthroplasty in sickle cell\u2013related osteonecrosis of the femoral head.<\/jats:p>","DOI":"10.1182\/hematology.2019000038","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T10:13:04Z","timestamp":1575627184000},"page":"351-358","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":58,"title":["Osteonecrosis in sickle cell disease: an update on risk factors, diagnosis, and management"],"prefix":"10.1182","volume":"2019","author":[{"given":"Oyebimpe O.","family":"Adesina","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Hematology, University of Washington School of Medicine, Seattle, WA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne D.","family":"Neumayr","sequence":"additional","affiliation":[{"name":"Department of Hematology, University of California, San Francisco, Benioff Children\u2019s Hospital, Oakland, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"3","key":"2019120610102197300_B1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1302\/0301-620X.74B3.1587879","article-title":"Hip arthroplasty in patients with sickle-cell haemoglobinopathy","volume":"74","author":"Acurio","year":"1992","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"2019120610102197300_B2","doi-asserted-by":"crossref","first-page":"156","DOI":"10.5581\/1516-8484.20120036","article-title":"Osteoarticular involvement in sickle cell disease","volume":"34","author":"da Silva Junior","year":"2012","journal-title":"Rev Bras Hematol Hemoter"},{"issue":"2","key":"2019120610102197300_B3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.2106\/JBJS.J.00919","article-title":"The natural progression of symptomatic humeral head osteonecrosis in adults with sickle cell disease","volume":"94","author":"Poignard","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"2019120610102197300_B4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.2174\/1874325000903010032","article-title":"Multifocal joint osteonecrosis in sickle cell disease","volume":"3","author":"Flouzat-Lachaniete","year":"2009","journal-title":"Open Orthop J"},{"issue":"12","key":"2019120610102197300_B5","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.2106\/00004623-200612000-00003","article-title":"Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. 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