How does osteonecrosis about the knee progress in young patients with leukemia? A 2- to 7-year study

E. J. Karimova, A. Wozniak, J. Wu, M. D. Neel, S. C. Kaste

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: Osteonecrosis is a major treatment complication of pediatric leukemias owing to its potential to cause joint deterioration. Because of potential long-term effects of osteonecrosis on joints, information regarding its progression and collapse in different patients can be used to identify high-risk groups, advise the patients and parents of this complication, and potentially consider the risk for development of osteonecrosis in planning primary treatment. Questions/purposes: We therefore determined: (1) the incidence of joint collapse and/or pain in young patients with hematologic malignancies diagnosed with ON of the knee; (2) risk factors associated with collapse; and (3) the relationship between size and location of osteonecrotic knee lesions and the likelihood of joint collapse. Patients and Methods: We retrospectively reviewed 109 patients with hematologic malignancies and MRI-confirmed knee osteonecrosis. The median age was 11.5 years (range, 2.3-18.8 years) at primary diagnosis of hematologic malignancy and a median age of 13.4 years (range, 2.7-23.3 years) at diagnosis of osteonecrosis of the knee. For analyses, we used the first and last MR images. Minimum clinical followup was 2.3 years after diagnosis of knee osteonecrosis (median, 6 years; range, 2.3-7.17 years). Results: Joint collapse occurred in 22% (24 of 109). Older age, pain at osteonecrosis presentation, and lesions extending to the articular surface of distal femoral epiphyses were associated with joint collapse. Conclusions: Younger patients and those without extensive femoral epiphyseal involvement have a better prognosis for osteonecrosis of the knee. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)2454-2459
Number of pages6
JournalClinical Orthopaedics and Related Research
Issue number9
StatePublished - Sep 2010

Bibliographical note

Funding Information:
One or more of the authors (SCK) have received funding from grants P30 CA-21765 from the National Institutes of Health, a Center of Excellence grant from the State of Tennessee, and the American Lebanese Syrian Associated Charities (ALSAC). Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at St Jude Children’s Research Hospital.

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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