AVN is a disease where there is necrosis of bone components due to temporary or permanent interruption of the blood supply, without blood, the bone tissue dies and the bone collapses.It most often affects the extremities of the long bones such as the femur leading to destruction of articular surfaces and resulting in hip and knee problems.
Factors that predispose paediatric oncology patients to AVN are:
- Radiotherapy (especially to weight-bearing bones)
- Bone marrow transplant
- Suboptimal nutrition
- Growth hormone deficiency (resulting from treatment)
- Inactivity/immobilisation
- Medications
- Steroids
- Cyclosporin
Clinical signs and symptoms
- Pain
- Loss of range of movement (ROM)
- Altered gait pattern
Treatment
- Analgesia
- Reduced weight bearing and rest
- Physiotherapy
- Surgical
- Drugs: biphosphonates
If you are concerned that a patient you are treating may have AVN, they need to be seen by orthopaedics. Liaise with the patient’s Paediatric Oncology Outreach Nurse Specialist (POONS) to arrange this.
Further information
CCLG Aftercure factsheet: Osteonecrosis or avascular necrosis Part of a series of late effects factsheets for teenage and young adult survivors of childhood cancer
Further reading
Patel B, Richards SM, Rowe JM, Goldstone AH, Fielding AK (2008) High Incidence of avascular necrosis in adolescents with acute lymphoblastic leukaemia: a UKALL XII analysis. Leukemia 22: 308-312
Marchese VG, Connolly B, Able C, Booten AR, Porter BM, Rai SN, Hancock ML, Pui CH, Howards Neel MDd, Kaste SC (2008) Relationships among severity of osteonecrosis, pain, range of motion, and functional mobility in children, adolescents and young adults with acute lymphoblastic leukemia. Physical Therapy 88 (3): 341-350
Goodman C, Snyder T (2007) Differential Diagnosis for Physical Therapists. 4th ed. St Louis, MO: Elsivier
Gilchrist L, Galantino M, Wampler M, Marchese VG, Morris GS, Ness KK (2009) A Framework for Assessment in Oncology Rehabilitation. Physical Therapy 89(3): 286-306