title: [Orthopedic diagnostic and therapeutic problems in avascular poststeroid necrosis of femur head in the course acute lymphoblastic leukemia--description of 3 cases].
abstract: BACKGROUND
  Chronic use of steroids in acute lymphoblastic leukemia is a significant supportive therapy. Whereas steroids have adverse effect on vessels leading to avascular osteonecrosis of femur head (ANFH). The aim of the study was to present a ANFH of three young persons diagnosed too late that ended with implantation of total hip arthoplasty (THA).
  Authors described chemotherapy of acute lymphoblastic leukemia according to established program. The fight for patient's life finished with success, but with side effect--ANFH. It was not diagnosed in an early period, because diagnosis was based only on X-ray of the hips. According to literature pain in the hip accompanying negative X-ray, should be supplemented with MRI, which allows confirmation of oedema of femur head bone marrow. Only early decompression in I degree of ANFH according to ARCO classification may stop a further progress of disease. Pain, impairment of gait, and necrosis covering over 30% of head was an indication for THA.
  
  
  CONCLUSIONS
  THA of hip among young people is allowed when joints are completely destroyed and painful.
authors.affiliation: Samodzielny Publiczny Szpital Kliniczny im. prof Adama Grucy w Otwocku. aleksandra.rapala@wp.pl
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Rapała
authors.forename: Piotr
authors.initials: P
authors.lastname: Walczak
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Truszczyńska
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D019299:Decompression, Surgical / Q000379:methods; D057210:Delayed Diagnosis; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011379:Prognosis; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones