DIAGNOSIS OF AVASCULAR NECROSIS OF THE FEMORAL-HEAD IN PATIENTS TREATED FOR LYMPHOMA

Avascular necrosis of bone (AVNB) is a well-known but rare complicatio n of chemotherapy for lymphoma with a reported incidence ranging from 1 to 10 per cent. Early diagnosis is essential for optimal therapeutic management. Using MRI, the most sensitive means of detecting the earl ier stages of AVNB, 100 patients treated with standard chemotherapy fo r lymphoma were assessed. Fifteen were found to have changes of AVNB, 10 with early changes but five with advanced segmental collapse of the femoral head. None with AVNB had more than the standard course of cor ticosteroids. Almost a quarter of the study group complained of joint pain during and/or after their treatment, a third of whom were found t o have AVNB; a strong indicator to screen all those with pain. However , 40 per cent of those with AVNB were asymptomatic. The clinical signi ficance of the 'silent hip' is yet to be elucidated.