Core Decompression for Osteonecrosis of the Femoral Head in Pediatric Hematologic Malignancy Survivors: A Systematic Review

Children treated for leukemia or lymphoma are predisposed to a higher incidence of osteonecrosis at a young age. Core decompression (CD) is performed for treatment of osteonecrosis of the femoral head (ONFH) to delay or prevent subchondral collapse and subsequent total hip arthroplasty (THA). The goal of the present systematic review was to determine outcomes of CD in pediatric patients with a history of hematologic malignancy who developed ONFH. Of 4,424 studies screened by title, abstract, and full text, 4 retrospective studies were included. Of 253 hips with ONFH, CD was performed in 78 (30.8%). Conversion to THA occurred in 46.2% of patients an average of 20.3 months after CD. None of the studies reported a significant difference in risk of joint collapse following CD. There is limited evidence for or against the use of CD in the treatment of ONFH for pediatric patients with a history of hematologic malignancy. Level of Evidence: Level III, Diagnostic study. (Journal of Surgical Orthopaedic Advances 35(1):010 – 013, 2026)

Key words: pediatric leukemia and lymphoma, osteonecrosis, core decompression