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Osteonecrosis of the femoral head in childhood malignancy

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Children undergoing chemotherapeutic treatment of malignancies have up to a 9 % incidence of osteonecrosis. The purpose of this article is to determine the time from initiation of chemotherapy to the onset of symptoms and the diagnosis of osteonecrosis of the femoral head in this patient population.

Methods

A retrospective review of the records of 18 patients (29 hips) under 21 years of age with both a diagnosis of osteonecrosis of the femoral head and childhood onset malignancy was undertaken to determine the time from initiation of chemotherapy to the onset of symptoms and diagnosis of osteonecrosis of the femoral head.

Results

Mean time from initiation of chemotherapy to the onset of pain was 18.8 months (8.0–49.1). The mean time from development of pain to diagnosis of osteonecrosis was 3.9 months (−13.1 to 25). The mean overall time from initiation of chemotherapy to diagnosis of osteonecrosis was 22.7 months (9.0–54.1). 11/18 patients had bilateral disease. 16/18 patients (21/29 hips) had already progressed to stage 4 osteonecrosis at the time of diagnosis.

Conclusions

There was a high incidence of stage 4 or greater osteonecrosis at the time of diagnosis. Providers caring for these patients should be aware of the potential for osteonecrosis, and the need for prompt diagnosis and referral to an orthopedic surgeon. Screening with advanced imaging studies may be warranted for children undergoing chemotherapeutic regimens for childhood malignancy to prevent delay in the diagnosis and management of this process so that joint preservation therapies remain an option.

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Conflict of interest

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC, 27710, USA

    Stephanie W. Mayer, Braden K. Mayer, James R. Urbaniak, Robert D. Fitch & Robert K. Lark

  2. Triangle Orthopaedic Associates, 120 William Penn Plaza, Independence Park, Durham, NC, 27704, USA

    J. Mack Aldridge

Authors
  1. Stephanie W. Mayer
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  2. Braden K. Mayer
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  3. J. Mack Aldridge
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  4. James R. Urbaniak
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  5. Robert D. Fitch
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  6. Robert K. Lark
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Corresponding author

Correspondence to Stephanie W. Mayer.

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Mayer, S.W., Mayer, B.K., Mack Aldridge, J. et al. Osteonecrosis of the femoral head in childhood malignancy. J Child Orthop 7, 111–116 (2013). https://doi.org/10.1007/s11832-012-0471-6

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  • DOI: https://doi.org/10.1007/s11832-012-0471-6

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