New method predicts hip joint decay from chemotherapy

St. Jude study shows that the extent of hip decay is key to predicting which survivors of leukemia/lymphoma who develop osteonecrosis of the femoral head will suffer hip joint collapse requiring surgical repair
Investigators at St. Jude Children's Research Hospital say they have found the best way for predicting when patients will need future surgery to repair hip joints that have deteriorated because of pediatric leukemia or lymphoma treatment.
The investigators found that if more than 30 percent of the head of the bone fitting into the hip socket is deteriorated, it is at high risk of collapsing and requiring reconstructive surgery within two years.
The study is significant because the intensive use of corticosteroid drugs that have been implicated in development of osteonecrosis, or bone deterioration, is a major component of chemotherapy for pediatric leukemia and lymphoma. The drugs have been key to raising the survival rates of children with these cancers, and currently there is no adequate substitute for their use. Therefore, it is important for clinicians to monitor patients during treatment and identify those at highest risk for this complication. Eventually, genetic or other tests may be developed to help predict these patients. This is a subject of ongoing study.
A report on this work appears in the April 20 issue of "Journal of Clinical Oncology."
Hip collapse occurs following deterioration of the ball-like top part of the upper leg bone, or femur, which fits into the hip socket. Degeneration of this area, called osteonecrosis of the capital femoral epiphysis, is a common problem among children undergoing chemotherapy for leukemia or lymphoma.
"Being able to predict which children are likely to experience serious bone deterioration in the future will help investigators identify and monitor survivors who are at particularly high risk for developing this problem," said Sue Kaste, D.O., a member of the Radiological Sciences department at St. Jude. Kaste is the paper's senior author.