Chemotherapy-induced femoral head avascular necrosis in patient with highly malignant non-Hodgkin’s lymphoma

Vol 5 | Issue 1 | January-June 2020 | page:10-13  | Olegs Stunzans, Peteris Studers, Ruta Jakusonoka

Authors: Olegs Stunzans [1], Peteris Studers [1], Ruta Jakusonoka [1]

[¹] Department of Orthopedics, Riga Stradins University, Riga, Latvija.
Address of Correspondence
Dr. Olegs Stunzans,
Tutor, Department of Orthopedics, Riga Stradins University, Riga, Latvija.


Introduction: Femoral head avascular necrosis (FHAN) in late arthritis stage leads to hip arthroplasty. Identification of at-risk patients, especially young haematological patients, and timely involvement of the orthopaedic surgeon are crucial. This is the first time in our clinical practice arthroplasty of both hips was performed on such a young patient with chemotherapy-induced FHAN.
Case Report: A clinical case of a 21-year-old male with bilateral femoral head osteonecrosis is presented, caused by the treatment of highly malignant, stage IIIB T cell non-Hodgkin’s lymphoma. Due to the underlying disease, the patient completed six courses of chemotherapy according to the VACPE and CHOP regimens that resulted in the development of FHAN; arthroplasty of both hips was indicated.
Conclusion: A closer collaboration between the therapists of the Clinic of Chemotherapy and Hematology and orthopedic surgeons should be encouraged to avoid treatment of severe osteonecrosis with arthroplasty in young patients.
Keywords: Osteonecrosis; Hip arthroplasty; Non-Hodgkin’s lymphoma.


1. Chihara D, Nastoupil L.J., Williams J.N., Lee P, Koff J.L., Flowers C.R.New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy. Expert Rev Anticancer Ther. 2015 May;Vol.15(5),pp: 531–544.
2. Karimova E.J., Rai S.N., Howard S.C., Neel M, Britton L, Pui C.H, Kaste S. C. Femoral head osteonecrosis in pediatric and young adult patients with leukemia or lymphoma. J Clin Oncol. 2007 Apr;Vol 25(12),pp:1525-31.
3. Shah K.N., Racine J., Jones L.C., Aaron R.K. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015 Sep; Vol 8(3),pp:201-9. 4 Roth A., Beckmann J., Bohndorf K., Fischer A., Heiß C., Kenn W., Jäger M., Maus U., Nöth U., Peters K.M., Rader C., Reppenhagen S., Smolenski U., Tingart M, Kopp I, Sirotin I, Breusch S J. S3-Guideline Non-Traumatic Adult Femoral Head Necrosis. Arch Orthop Trauma Surg . 2016 Feb; Vol 136(2),pp:165-74.
5. Sultan A.A., Mohamed N., Samuel L.T., Chughtai M., Sodhi N., Krebs V.E., Stearns K.L., Molloy R.M, Mont M.A. Classification systems of hip osteonecrosis: An Updated Review. Review Int Orthop. 2019 May; Vol 43(5), pp:1089-1095.
6. Mont M.A., Hungerford D.S. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995; Vol.77,pp:459–474.
7. Mankin H. J., Nontraumatic necrosis of bone (osteonecrosis) N Engl J Med. 1992 May; Vol 326,pp:1473–9.
8. Mont M.A., Carbone J.J, Fairbank A.C. Core Decompression Versus Nonoperative Management for Osteonecrosis of the Hip. Clin Orthop Relat Res. 1996 Mar; Vol 324,pp:169-78.
9. Gangji V., Maertelaer V.D., Hauzeur JP. Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: five year follow-up of a prospective controlled study. Bone. 2011 Nov; Vol.49(5), pp:1005-9.
10. Hua KC., Yang XG., Feng JT, Wang F., Yang L, Zhang H., Hu YC. The Efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis. J Orthop Surg Res. 2019 Sep.
11. Wang Z., Sun QM., Zhang FQ., Zhang QL., Wang LG., Wang WJ. Core Decompression combined with autologous bone marrow stem cells versus core decompression alone for patients with osteonecrosis of the femoral head: a meta-analysis. Int J Surg . 2019 Sep; Vol.69,pp:23-31.
12. Kang J.S., Suh Y.J., Moon K.H., Park J.S., Roh T.H., Park M.H., Ryu D.J. Clinical efficiency of bone marrow mesenchymal stem Cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther. 2018 Oct Vol.25.
13. Tetik C., Başar H., Bezer M., Erol B., Ağir I., Esemenli T. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc. 2011; Vol 45(5),pp:326-34.
14. Zhang C., Zeng B., Xu Z., Song W., Shao L., Jing D., Sui S. Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report. Microsurgery. 2005; Vol.25(4),pp:305-9.
15. Yin S., Zhang C., Jin D., Chen S., Sun Y., Sheng J. Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting. Int Orthop.2011 Aug; Vol.35(8), pp:1125–1130.
16. Sakano S., Hasegawa Y., Torii Y., Kawasaki M., Ishiguro N. Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004 Apr; Vol.86(3),pp:359-65.
17. Ikemura S., Yamamoto T., Jingushi S., Nakashima Y., Mawatari T., Iwamoto Y. Leg-length discrepancy after transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br.2007 Jun;Vol.89(6),pp:725-9.
18. Zhao G., Yamamoto T., Ikemura S., Motomura G., Mawatari T., Nakashima Y., Iwamoto Y. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br .2010 Jun; Vol.92(6),pp:781-6.
19. Okura T., Hasegawa Y., Morita D., Osawa Y., Ishiguro N. What factors predict the failure of curved intertrochanteric varus osteotomy for the osteonecrosis of the femoral head? Arch Orthop Trauma Surg. 2016 Dec;Vol.136(12),pp:1647-1655.
20. Ritter M.A., Helphinstine J., Keating E.M., Faris P.M., Meding J.B. Total hip arthroplasty in patients with osteonecrosis. The effect of cement techniques. Clin Orthop Relat Res. 1997;Vol.338,pp: 94–99.
21. Hartley W.T., McAuley J.P., Culpepper W.J., Engh C.A. Jr., Engh C.A. Sr. Osteonecrosis of the femoral head treated with cementless total hip arthroplasty. J Bone Joint Surg Am. 2000;Vol 82,pp:1408–1413.

How to Cite this Article:  Stunzans O, Studers P, Jakusonoka R | Chemotherapy-induced femoral head avascular necrosis in patient with highly malignant non-Hodgkin’s lymphoma | Journal of Orthopaedic and Rehabilitation | 2020 January-June; 5(1):10-13.

 (Abstract)      (Full Text HTML)      (Download PDF)