BONE AND JOINT COMPLICATIONS IN PEDIATRIC CANCER SURVIVORS: ORTHOPEDIC AND ONCOLOGIC PERSPECTIVES

Abstract

Background: While advances in pediatric oncology have led to substantial improvements in survival, the long-term musculoskeletal complications faced by survivors remain underrecognized. This study investigated bone and joint health outcomes in pediatric cancer survivors through an integrated orthopedic and oncologic lens.

Methods: A mixed-methods experimental design was applied, combining quantitative measures of bone mineral density (BMD), joint range of motion (ROM), muscle strength, pain scores, fracture incidence, and growth abnormalities with qualitative interviews exploring functional challenges and survivorship experiences. Results were organized across nine analytical tables and twelve figures to provide a comprehensive overview.

Results: At baseline, many survivors exhibited significantly reduced BMD, with adolescents showing the greatest deficits. Longitudinal follow-up revealed partial but incomplete recovery, particularly among those exposed to corticosteroids and radiotherapy. ROM assessments identified persistent restrictions in hip and knee joints, and muscle strength analysis revealed poorer outcomes in heavily treated groups. Pain scores were concentrated in lower extremities, while fracture incidence was strongly correlated with combined steroid and radiotherapy exposure. Survivors diagnosed with osteonecrosis experienced severe functional limitations, and growth abnormalities such as limb length discrepancies and angular deformities were most prevalent among sarcoma survivors. Orthopedic interventions—including surgical corrections and physiotherapy—were associated with marked improvements in mobility and functional independence. Qualitative findings aligned with quantitative data, highlighting survivor-reported challenges in mobility, chronic pain, and psychosocial well-being.