Children receiving corticosteroid therapy for leukemia or lymphoma who develop deterioration of the femoral head of 30 percent or more are at high risk for collapse of the bone and need for reconstructive surgery within two years, according to an article in the April 20 issue of the Journal of Clinical Oncology.

Researchers at Saint Jude Children’s Hospital retrospectively reviewed charts and magnetic resonance imaging scans for 80 patients who developed osteonecrosis of the femoral head. Logistic regression was then used to evaluate possible risk factors and outcomes of joint surface collapse and reconstructive arthroplasty.

The median time between primary diagnosis and diagnosis of osteonecrosis was 1.7 years (range, 0.1-17.5 years). A total of 23 patients (29 percent) underwent arthroplasty of 36 hip joints (mean, 1.3 years; range, 0.5-35.4 years). Median age at time of surgery was 20.1 years (range, 15.1-35.4 years).

Percent of involvement of the femoral head at time of diagnosis of osteonecrosis was the only factor to predict collapse requiring surgery: 80 percent of these hips collapsed within two years; half required arthroplasty.

"Being able to predict which children are likely to experience serious bone deterioration in the future will help investigators identify and monitor those survivors who are at particularly high risk for developing this problem," said Sue Kaste, DO, a member of the Radiological Sciences department at St. Jude and the paper's senior author.