Symptomatic Osteonecrosis of the Hip and Knee After Cardiac Transplantation

Lieberman, Jay R.; Roth, Kevin M.; Elsissy, Peter; Dorey, Frederick J.; Kobashigawa, Jon A.

doi:10.1016/j.arth.2007.01.006

« Previous Next »The Journal of Arthroplasty
Volume 23, Issue 1 , Pages 90-96, January 2008

Symptomatic Osteonecrosis of the Hip and Knee After Cardiac Transplantation

Jay R. Lieberman, MD
- The Musculoskeletal Institute and the Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut
- Reprint requests: Jay R. Lieberman, MD, The New England Musculoskeletal Institute and the Department of Orthopaedic Surgery, University of Connecticut Health Center, Medical Arts and Research Building, 263 Farmington Ave, Farmington, CT 06030-5456.
Kevin M. Roth, BA
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
Peter Elsissy, MD
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California
Frederick J. Dorey, PhD
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
Jon A. Kobashigawa, MD
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

Received 9 July 2006; accepted 8 January 2007.

Abstract

Patients who are treated with steroids for immunosuppression after solid organ transplant are at risk for development of osteonecrosis. The purpose of this study was to determine the prevalence of symptomatic osteonecrosis of the hip and knee in patients who were treated with corticosteroids after cardiac transplantation and to determine if there was a relationship between steroid dose and the development of osteonecrosis. We retrospectively evaluated 204 patients who underwent cardiac transplantation and noted that only 6 (3%) of 204 patients developed symptomatic osteonecrosis of the hip or knee. The osteonecrosis was diagnosed an average of 38.5 months (range, 21-52 months) after transplantation. There was no association noted between steroid dose and the development of symptomatic osteonecrosis. The low prevalence of osteonecrosis supports the hypothesis that the development of osteonecrosis in these patients is an idiosyncratic response to steroids, perhaps related to an underlying hypercoagulable state or hypofibrinolysis.

Key words: osteonecrosis, cardiac transplantation, immunosuppression, steroids