Abstract
Introduction:
The outcome of previous cemented total hip arthroplasty has been reported to be inferior in renal transplant patients because of poor bone stock resulting from long-term steroid use. Moreover, as renal transplant patients remain on immunosuppressant therapy for life, higher levels of overall morbidity must be considered. We evaluated the mid-term results of cementless total hip arthroplasty in renal transplant recipients with osteonecrosis of the femoral head, and compared those with age and sex matched osteonecrosis patients that had not undergone organ transplantation or been treated with long-term steroid.
Materials & Methods:
Between October 1997 and October 2008, 45 consecutive primary cementless total hip arthroplasties were performed in 30 patients with advanced osteonecrosis of the femoral head after renal transplantation. There were 18 males (27 hips) and 12 females (18 hips) of overall mean age 44 years (22 to 68). The clinical and radiographic results of cementless total hip arthroplasty in these 45 hips were compared with those of 96 sex and age-matched osteonecrotic hips of 72 patients that had not undergone organ transplantation or long-term steroid use. Patients were evaluated at surgery and at a mean of 7.2 years (range, 2–13 years) postoperatively.
Results:
The mean Harris hip score of patients improved from 48 points preoperatively to 94 points at last follow-up (p < 0.05). Three hips in patient group had massive osteolysis with polyethylene wear requiring revision surgery. One hip in the patient group underwent revision surgery because of recurrent dislocation at 11 years postoperatively. No intergroup differences in overall rates of complications or revisions were observed. However, patients had a significantly higher rate of ectopic ossification.
Conclusion:
Despite diffuse osteopenia and chronic immunosuppression in renal transplant patients with osteonecrotic hips, contemporary cementless total hip arthroplasty showed durable implant fixation to bone and did not increase complications.
