We present the clinical aspects of avascular osteonecrosis in children with sickle-cell disease and emphasize the need for early detection of this necrosis of the femoral head, which is often nearly or totally asymptomatic. This retrospective descriptive study covers the 10 years from January 1989 through December 1999 and includes 22 homozygous (Hb-SS) children and adolescents with sickle-cell disease, all presenting pain in the hip and/or limping. The sex ratio was 2.6 (72% boys). Epiphyseal infarction in these children can concern the femoral as well as the humeral head. Femoral osteonecrosis is disabling and often has severe complications, involving not only functional prognosis but also growth potential. Patient and family education is essential to facilitate early diagnosis and treatment and avoid severe consequences in adulthood.
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