Femoral Head Necrosis After Kidney Transplantation

Abstract

From January 1, 1993 through July 31, 1997, 184 kidney transplantations were performed at our center. Of these patients, 173 entered regular follow-up at the transplantation clinic. Five patients (2.8%) developed hip pain during this interval and were referred to the orthopedic clinic. Of these five patients, four were men and one was a woman. Their average age was 38.2 years (range 27 to 45 years). All had been undergoing hemodialysis for an average of 13.2 months (range 3 to 25 months) before their kidney transplantations. After transplantation, they received a triple-drug immunosuppressive regimen of deltacortisone, azathioprine, and cyclosporine (CyA). The patients developed symptoms of femoral head avascular necrosis at an average of 11.4 months (range 7 to 18 months) posttransplantation. Among the five patients, six hip joints were symptomatic and painful. Using both plain radiography and magnetic resonance imaging (MRI) studies, all 10 hip joints were diagnosed with ARCO (Association Research Circulation Osseous) stage 1 avascular necrosis of the femoral head. The patient with bilaterally painful hip joints was managed conservatively with rest and range of motion and muscle-strengthening exercises. Three patients were managed with surgical treatment of the symptomatic hip by core decompression and conservative treatment of the asymptomatic hip. One patient with one symptomatic hip underwent bilateral core decompressions.