title: Osteonecrosis of the femoral head in childhood malignancy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC 27710 USA.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Mayer
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC 27710 USA.
authors.forename: Braden K
authors.initials: BK
authors.lastname: Mayer
authors.affiliation: Triangle Orthopaedic Associates, 120 William Penn Plaza, Independence Park, Durham, NC 27704 USA.
authors.forename: J
authors.initials: J
authors.lastname: Mack Aldridge
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC 27710 USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Urbaniak
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC 27710 USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Fitch
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 2923, 200 Trent Drive, Room 5309, Duke Clinic Building, Durham, NC 27710 USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Lark
keywords: Avascular necrosis of the femoral head; Chemotherapy; Malignancy; Osteonecrosis of the femoral head