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Acetabular avascular necrosis following high-dose steroid treatment and chemotherapy for leukemia

Computer tomography analysis of treatment with impaction bone grafting

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A Correction to this article was published on 27 December 2019

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Abstract

Avascular necrosis (AVN) of the bone is thought to be a serious complication of treatment for acute lymphoblastic leukemia (ALL). The acetabulum is an unusual area to be affected by AVN, and there are currently no reports of successful joint salvage procedures found in the literature. We present a case of a 20-year-old man with ALL who was diagnosed with debilitating AVN of both acetabula 2 years following initial diagnosis of ALL and treatment with a multi-agent chemotherapy regimen including high-dose corticosteroids. After unsuccessful treatment with bisphosphonate therapy, the acetabular AVN underwent bilateral curettage and impaction bone grafting to prevent collapse of subchondral fractures with the hope of salvaging both hip joints. Computer tomography (CT) of the AVN affected areas, pre- and post-bone impaction grafting, demonstrated healing of the subchondral fractures and a doubling of bone density that was maintained at 2 years after surgery. The patient resumed full weight-bearing at 3 months after first surgery, continues to ambulate unrestricted, and remains pain free 3 years post-surgery.

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Change history

  • 27 December 2019

    Unfortunately in Volume 49, Issue 1 had been published online with an incorrect date (2001 instead of 2020).

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Authors and Affiliations

  1. Discipline of Orthopedics & Trauma and Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA, 5000, Australia

    Daud Tai Shan Chou & Lucian Bogdan Solomon

  2. Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Daud Tai Shan Chou & Lucian Bogdan Solomon

  3. Medical Device Research Institute, College of Science and Engineering, Flinders University, 1284 South Road, Adelaide, SA, 5042, Australia

    Mark Taylor

  4. South West London Elective Orthopaedic Centre and Epsom & St Helier NHS Trust, Dorking Rd, Epsom, Surrey, KT18 7EG, UK

    Markus Baker

  5. Orthopaedics & Trauma, Orthopädie Unfallchirurgie Staphanshorn AG, 9016, St. Gallen, Switzerland

    Patrick Studer

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  1. Daud Tai Shan Chou
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Correspondence to Daud Tai Shan Chou.

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Informed consent was obtained from the patient included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chou, D.T.S., Taylor, M., Baker, M. et al. Acetabular avascular necrosis following high-dose steroid treatment and chemotherapy for leukemia. Skeletal Radiol 49, 147–154 (2020). https://doi.org/10.1007/s00256-019-03244-7

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  • DOI: https://doi.org/10.1007/s00256-019-03244-7

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