Avascular necrosis in children with acute lymphoblastic leukemia

This study describes the prevalence and demographics of avascular necrosis (AVN) in children with acute lymphoblastic leukemia (ALL). With improving s urvival of ALL patients on modem chemotherapy regimens, an increasing numbe r of children with AVN will be presenting to orthopaedists. From 1991 to 19 96, 202 patients were treated for ALL at a major tertiary pediatric cancer referral center. Eight patients (4.0%) subsequently developed AVN at an ave rage of 30.0 months after beginning chemotherapy. A total of 27 documented joints were involved, with an average of 3.4 joints affected per patient di agnosed with AVN. The subset of patients with high-risk ALL who underwent a n aggressive chemotherapy protocol was particularly susceptible to developi ng AVN. Six of 58 high-risk ALL patients (10.3%) developed AVN at an averag e of 18.5 months. As ALL patients now frequently survive into adulthood, or thopaedists will be increasingly called on to manage AVN affecting multiple joints in children and young adults.