J Korean Hip Soc.  2010 Jun;22(2):166-170. 10.5371/jkhs.2010.22.2.166.

Total Hip Arthroplasty for Osteonecrosis of the Femoral Head Following Cardiac Transplantation: A Case Report

• Kim HW
• Yoon TR
• Cho YJ

• KMID: 1461139
• DOI: http://doi.org/10.5371/jkhs.2010.22.2.166

Abstract

Cardiac transplantation has become the treatment of choice for end stage heart disease, and the long-term survival rates of cardiac transplant patients continue to improve, due to the continued improvements made in operation methods and postoperative immunological therapies. However, the incidences of disabling orthopedic complications, such as, osteopenia, osteoporosis, fractures, and osteonecrosis, have been increased by the postoperative administrations of steroids and immunosuppressive agents. Accordingly, several orthopedic surgeons have evaluated treatments for these complications, and a number of reports have been issued on osteonecrosis after cardiac transplantation. However, all of these reports have been issued is the US and European countries, and in particular, no report has been published on osteonecrosis following cardiac transplantation in an Asian patient. In this report, the authors report the case of a patient who underwent total hip arthroplasty due to osteonecrosis of the femoral head after cardiac transplantation.

Keyword

Cardiac transplantation; Osteonecrosis of femoral head; Total hip arthroplasty

MeSH Terms

Arthroplasty
Asian Continental Ancestry Group
Bone Diseases, Metabolic
Head
Heart Diseases
Heart Transplantation
Hip
Humans
Immunosuppressive Agents
Incidence
Orthopedics
Osteonecrosis
Osteoporosis
Steroids
Survival Rate
Transplants
Immunosuppressive Agents
Steroids

Figure

• 

  Fig. 1 (A, B) The anteroposterior and lateral radiographs of pelvis show a large synovial pit at the right femoral neck. (C) T1 weighted coronal MR image show an area of low and intermediate signal intensity lesion on both sides femoral head.

• 

  Fig. 2 (A, B) Postoperative 26-month anteroposterior and lateral radiographs of pelvis show stable bony ingrowth without radiolucent lines or migration.

Reference

1. Barnard CN. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape town. S Afr Med J. 1967. 41:1271–1274.

2. Roussel JC, Baron O, P?rigaud C, et al. Outcome of heart transplants 15 to 20 years ago: graft survival, post-transplant morbidity, and risk factors for mortality. J Heart Lung Transplant. 2008. 27:486–493.

3. Bradbury G, Benjamin J, Thompson J, Klees E, Copeland J. Avascular necrosis of bone after cardiac transplantation. Prevalence and relationship to administration and dosage of steroids. J Bone Joint Surg Am. 1994. 76:1385–1388.

4. Danzig LA, Coutis RD, Resnick D. Avascular necrosis of the femoral head following cardiac transplantation: report of a case. Clin Orthop Relat Res. 1976. 117:217–220.

5. Fisher DE, Bickel WH, Holley KE, Ellefson RD. Corticosteroid-induced aseptic necrosis. II. Experimental study. Clin Orthop Relat Res. 1972. 84:200–206.

6. Li X, Jin L, Cui Q, Wang GJ, Balian G. Steroid effects on osteogenesis through mesenchymal cell gene expression. Osteoporos Int. 2005. 16:101–108.

7. Korompilias AV, Gilkeson GS, Seaber AV, Urbaniak JR. Hemorrhage and thrombus formation in early experimental osteonecrosis. Clin Orthop Relat Res. 2001. 386:11–18.

8. Leön JL, Resines C, Zafra A. Total hip arthroplasty in heart transplant patients. Acta Orthop Belg. 2007. 73:720–728.

9. Fisher DE, Bickel WH. Corticosteroid-induced avascular necrosis. A clinical study of seventy-seven patients. J Bone Joint Surg Am. 1971. 53:859–873.

10. Kanter SF, Samuel SI. Anesthesia for major operations on patients who have transplanted hearts, a review of 29 cases. Anesthesiology. 1977. 46:65–68.

11. Burton DS, Mochizuki RM, Halpern AA. Total hip arthroplasty in the cardiac transplant patient. Clin Orthop Relat Res. 1978. 130:186–190.

12. Isono SS, Woolson ST, Schurman DJ. Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients. Clin Orthop Relat Res. 1987. 217:201–208.

13. Bockman RS, Weinerman SA. Steroid-induced osteoporosis. Orthop Clin North Am. 1990. 21:97–107.

14. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987. 69:45–55.

15. Yoon TR, Park KS, Song EK, Seon JK, Seo HY. New two-incision minimally invasive total hip arthroplasty: comparison with the one-incision method. J Orthop Sci. 2009. 14:155–160.