Osteonecrosis after chemotherapy in children

Abstract

The application of modern chemotherapy protocols has improved healing and survival rates significantly in pediatric malignancies. As a result, the long-term drug-related side effects are becoming increasingly apparent. Avascular osteonecrosis (AVN) occurs in up to 40% of all patients who have undergone chemotherapy, the average time of onset being 12-18 months after chemotherapy. Compared to other bones, the weight-bearing regions of hip and knee joints are most commonly affected. Incidentally and in early stages, AVN may show only mild symptoms or may not be clinical apparent. Typical risk factors for AVN after chemotherapy are the application of glucocorticoids and an age of 10 ys. and older. The etiology remains unclear. In early stages, AVN can be detected by magnetic resonance imaging (MRI). Evidence-based, standardized therapeutic concepts or orthopedic guidelines are not available for these patients to date. The range of treatment options includes several operative and non-operative treatment alternatives.