Osteonecrosis requiring total joint arthroplasty is a rare sequel in children and young adults treated for solid tumors

Figures & data

Table I. Patients with total joint arthroplasty in different cancer groups.

Primary diagnosis	Patients with TJA n (hip/knee)	Total no. of patients	Person- years	IR per 1000 person-years (95% CI)	Mean age in years (range) at cancer diagnosis among patients with TJA	Mean age in years (range) at time of TJA	Mean time in years (range) from cancer diagnosis to TJA
Kidney tumor	3 (2/1)	536	9572	0.3 (0.07–0.9)	10.2 (1.2–22.8)	24.0 (20.1–29.7)	13.8 (6.8–18.8)
Breast tumor	4 (3/1)	848	15 520	0.3 (0.07–0.7)	28.1 (25.2–30.4)	32.6 (30.1–34.2)	4.5 (2.0–5.9)
Testicular tumor	6 (3/3)	3347	59 369	0.1 (0.04–0.2)	25.3 (22.0–28.6)	33.0 (24.6–37.5)	7.7 (2.7–14.7)
Other tumor	7 (7/0)	6578	116 187	0.06 (0.02–0.1)	23.1 (2.1–29.3)	30.0 (15.4–38.3)	7.0 (0.3–13.3)
CNS tumor	3 (2/1)	4637	78 211	0.04 (0.01–0.1)	19.4 (7.5–27)	30.0 (21.3–29.4)	10.6 (2.4–15.5)
Melanoma	2 (1/1)	2596	42 115	0.05 (0.01–0.2)	29.5 (28.4–30.6)	37.3 (34.7–39.9)	7.8 (6.3–9.4)
All cancers	25 (18/7)	18 542	320 974	0.08 (0.05–0.12)	22.9 (1.2–30.6)	31.0 (20.1–39.9)	8.1 (0.3–18.8)

CI, cumulative incidence; CNS, central nervous system; IR, incidence rate; TJA, total joint arthroplasty.

Table II. Characteristics of patients with solid tumors who developed osteonecrosis requiring total joint arthroplasty.

Case	Gender/age at diagnosis in years	Solid tumor according to ICD-7/ICD-10	Histology	Age at diagnosis of TJA in years	Time in years to TJA after cancer diagnosis	Involved site
1	M/24	Mediastinum	Yolk sac tumor	33	9.2	Hip
2	F/26	Ascending colon	Carcinoid tumor	34	8.3	Hip
3	F/31	Malignant melanoma of lower limb, including hip	Malignant melanoma	40	9.4	Hip
4	F/2	Primary liver tumor	Embryonal tumor	15	13.3	Hip
5	F/29	Thyroid gland	Follicular adenocarcinoma	34	4.4	Hip
6	F/28	Malignant melanoma of overlapping sites of skin	Nodular melanoma	35	6.3	Knee
7	F/28	Vulva	Peripheral neuroectodermal tumor	31	3.0	Hip
8	F/24	Border of tongue	Squamous cell carcinoma	25	0.3	Hip
9	F/23	Malignant neoplasm of kidney	Renal cell carcinoma	30	6.8	Hip
10	F/1	Malignant neoplasm of kidney	Nephroblastoma	20	18.8	Hip
11	M/7	Malignant neoplasm of kidney	Nephroblastoma	22	15.7	Knee
12	M/8	Craniopharyngeal duct	Craniopharyngeoma	21	13.9	Hip
13	F/24	Brain, supratentorial	Unknown	39	15.5	Knee
14	M/27	Brain stem	Hemangioblastoma	29	2.4	Hip
15	M/26	Testis	Seminoma	37	11.6	Knee
16	M/23	Testis	Embryonal carcinoma	37	14.7	Knee
17	M/29	Testis	Malignant teratoma	37	8.3	Knee
18	M/22	Testis	Teratocarcinoma	25	2.7	Hip
19	M/29	Testis	Embryonal carcinoma	35	6.0	Hip
20	M/24	Testis	Embryonal carcinoma	27	3.1	Hip
21	F/29	Breast	Lobular carcinoma	34	5.1	Hip
22	F/30	Breast	Adenocarcinoma	32	2.0	Hip
23	F/28	Breast	Medullary carcinoma	34	5.9	Knee
24	F/25	Breast	Lobular carcinoma	30	4.9	Hip
25	F/28	Ovary	Papillary serous cystadenoma	38	10.4	Hip