Risk Factors Associated With Osteonecrosis of the Femoral Head in Patients With Sickle Cell Disease: A Systematic Review and Meta-Analysis.

Osteonecrosis of the femoral head (ONFH) is a serious complication in patients with sickle cell disease (SCD), secondary to the peculiar pathophysiology of the disease. SCD is characterized by stiff and adhesive RBCs, disturbing blood circulation, and causing ischemia and microvascular damage. Understanding the key risk factors contributing to ONFH in this population is critical for developing targeted interventions to improve outcomes in this population. This study aimed to identify and analyze the key risk factors associated with osteonecrosis of the femoral head (ONFH) in patients with sickle cell disease (SCD) through a comprehensive systematic review and meta-analysis. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) tool to search and select the most relevant studies from electronic databases, like Web of Science, Google Scholar, PubMed, Cochrane Library, Embase, and MEDLINE, based on the study focus. The following medical phrases were used in the search: femoral head, aseptic necrosis, osteonecrosis, predictor, risk factor, and sickle cell disease. The study included six studies with a total of 581 participants. Four significant risk factors for ONFH in SCD were identified as follows: genotype (risk ratio: 1.09, 95% CI: 0.94-1.27), elevated hemoglobin levels (mean difference: 0.30, 95% CI: -0.03 to -0.63), hip pain (risk ratio: 1.11, 95% CI: 0.80-1.55), and acute chest pain (mean difference: 1.17, 95% CI: 0.87-1.47). Statistical analysis showed low heterogeneity across studies (I²: 0%, p < 0.05), indicating consistent findings. The ONFH group was more significantly affected by these factors than the comparator group. The meta-analysis revealed an intricate interplay of vascular, hematologic, and systemic factors contributing to ONFH of SCD with the four significant risk factors mainly genotype, elevated hemoglobin levels, hip pain, and acute chest pain. Therefore, it is important to carry out regular check-ups and focus on specific treatments to manage these clearly identified risk factors, which can help slow down the progression of the disease.