Aseptic Osteonecrosis in Children and Adolescents Treated for Hemato-Oncologic Diseases

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Aseptic osteonecrosis (AON) is a serious long-term complication of childhood cancer therapy. A retrospective study was undertaken to describe treatment and long-term follow-up of patients with AON. Between 1990 and 2003, 630 consecutive children with various malignancies were treated at the University Children's Hospital in Graz, Austria. In nine of these patients presenting with skeletal symptoms, MRI revealed AON. All nine had hematologic malignancies. The median age at diagnosis of malignancy was 15.8 years (range 13.7-18.6 years), and the median interval between diagnosis of malignancy and onset of osteonecrosis-related symptoms was 16 months (range 6-53 months). All patients had received previous corticosteroid therapy. Treatment of AON included restriction of weight-bearing, physiotherapy, and analgesics. Three patients were treated with hyperbaric oxygen therapy combined with the prostacyclin analog iloprost, and one patient also received pamidronate, a second-generation bisphosphonate. This conservative treatment resulted in alleviation of symptoms in all patients. One patient had to undergo bilateral hip replacement and two had to undergo arthrotomy with sequestrotomy due to subsequent deterioration of symptoms. Close monitoring for skeletal symptoms is mandatory during follow-up of patients with hematologic malignancies. Previous corticosteroid treatment and age older than 10 years seem to be major risk factors. Early detection of AON leading to prompt intervention may prevent more severe morbidity.