Today's News

Thursday, February 04, 1999

Study: ALL children have high incidence of avascular necrosis

"The subset of ALL patients undergoing an aggressive chemotherapy protocol with high-dose prednisone for high-risk disease was particularly susceptible to developing AVN," said co-author Steven Y. Wei, MD, resident, department of orthopaedic surgery, University of Pennsylvania Health System, Philadelphia. "Ten percent of these patients had AVN, all within the first two years of chemotherapy.

"As the survivorship of ALL patients improves with modern chemotherapy regimens, more children with AVN will be presenting to orthopaedists," he said.

Dr. Wei and colleagues reviewed patient records at a major tertiary pediatric hospital to identify patients diagnosed with ALL between 1991 and 1996, and those who developed AVN during chemotherapy. "The diagnosis of AVN was confirmed with plain radiographs, bone scans and/or magnetic resonance imaging," said Dr. Wei, who presented the findings in poster exhibit 176 Thursday.

A total of 202 patients, average age 6.5 years (range: 1 to 18 years), were diagnosed with ALL. Eight patients (4 percent) subsequently developed AVN; 27 joints were involved, an average of 3.4 joints per patient (range: two to eight joints).

The affected joints were 12 hips (44.4 percent); eight knees (29.6 percent); three ankles (11.1 percent); two shoulders (7.4 percent); and two elbows (7.4 percent).

"Orthopaedic surgeons will be increasingly called upon to manage AVN affecting multiple joints in children and young adults," he concluded.

Co-authors of the study with Dr. Wei are John P. Dormans, MD, associate professor, department of orthopaedic surgery, University of Pennsylvania Health System; and Nancy Bunin, MD, associate professor of pediatrics, Children's Hospital of Philadelphia.