Avascular necrosis of the femoral head in children with chronic renal disease

PURPOSE: To determine the incidence of avascular necrosis (AVN) of the femo ral head in children with chronic renal failure. MATERIALS AND METHODS: Pelvic radiographs in 205 children (age range, 6 mon ths to 16 years; mean age, 6 years +/- 3.5 [SDI) with chronic renal failure were reviewed. Serial radiographs were obtained every 6 months for 1-7 yea rs (mean, 3 years +/- 2) to assess the presence of AVN of the femoral head; six children had metabolic renal disease, 21 had acquired renal disease, a nd 178 had structural renal lesions. RESULTS: Radiographic findings of AVN were seen in 14 of 205 patients (appr oximately one in every 15). The frequency of AVN was similar in boys and gi rls; AVN was observed in 11 (6.9%) of 159 boys and in three (6.5%) of 46 gi rls and was not related to the duration of renal disease, type of renal dis ease, or growth hormone therapy. Affected children were frequently asymptom atic, and, when present, the clinical complaints were mild. In two instance s, AVN developed while the patients were receiving corticosteroids before e ntering this study. CONCLUSION: The results of this study indicate that AVN of the femoral head is a frequent complication in children with chronic renal failure, occurri ng in approximately 7% of this population. Unlike Legg-Calve-Perthes diseas e, AVN in children with chronic renal failure is frequently asymptomatic an d has no sex predilection.