The problem of avascular necrosis of bone in patients treated for Hodgkin's disease

Seven patients treated for Hodgkin's disease by chemotherapy and radiotherapy developed avascular necrosis of the heads of long bones (femur in six cases, humerus in one case). The use of steroids has been correlated with the appearance of this uncommon complication but steroids may not be the only aetiological factor. The roles of radiotherapy, chemotherapeutic agents and trauma have not been clarified in previously published accounts. The importance of trauma as a cofactor is emphasised and it is suggested that patients at risk try to avoid trauma and excessive mechanical stress. The role of radiation is less clear, though shielding the heads of long bones is recommended when clinically appropriate. Early orthopaedic referral with hip-joint replacement or bone grafting reduces the short-term morbidity of this condition, though the long-term prognosis after surgery is uncertain. Although this complication of treatment is uncommon it may inflict disability and occupational disturbance on otherwise healthy patients who have the prospect of long-term survival.