Non-traumatic avascular necrosis of femoral head in malignant disease: Is it disease induced or treatment related?

Avascular necrosis (AVN) of the femoral head is a poorly understood pathologic process often seen with neoplastic process either due to it or its treatment. The pathology is ischaemic bone necrosis and joint collapse or it may be asymptomatic and missed easily. We have described three young patients with AVN. They developed symptomatic AVN within 3 years of treatment while in remission at a stage where a surgical treatment was mandatory. AVN is under-diagnosed and thus exact incidence is unknown. Non-traumatic AVN occurs usually in young age, may occur early or very late after treatment. The AVN can occur due to malignant process itself or subsequent treatment. The mainstay of management is prompt diagnosis, appropriate prognostication, and justified management. The conservative measures and joint-sparing procedures often fail due to late stage diagnosis. Research to understand the pathobiology of AVN and to develop therapies offers promise for the future successful management. Technological improvements in surgical methods have also improved outcomes and will help patients recover from this functionally debilitating disease. AVN is an under-diagnosed pathology with high morbidity, and considerable cost of management if diagnosed late. A clinical suspicion in every cancer patient, comprehensive clinical evaluation, early diagnosis and prompt management decrease morbidity, cost and improves management outcome. Appropriate close and focused screening in eligible patients is desirable. Research to understand the pathobiology of AVN and to develop therapies that can be translated to clinical application has progressed.