Cementless total hip arthroplasty in renal transplant patients
ABSTRACT We present our experience of contemporary cementless total hip arthroplasty (THA) conducted at a single institution to treat advanced avascular necrosis (AVN) in renal transplant patients. Between October 1997 and October 2008, 45 consecutive primary cementless THAs were performed in 30 patients with advanced AVN after renal transplantation. There were 18 males (27 hips) and 12 females (18 hips) (patient group) with an overall mean age 44 years (22 to 68). The clinical and radiographic results were compared with those of 96 sex and age-matched osteonecrotic hips in 72 patients that had not undergone organ transplantation or long-term steroid therapy (the control group). Patients were evaluated at surgery and at a mean of 7.2 years (2 to 13 years) postoperatively. 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 the 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, transplant patients had a significantly higher rate of ectopic ossification. Despite diffuse osteopenia and chronic immunosuppression in renal transplant patients with osteonecrotic hips, cementless THA showed durable implant fixation to bone and no increased risk of complications.
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ABSTRACT: Lung transplantation is increasingly common with improving survival rates. Post-transplant patients can be expected to seek total hip (THA) and knee arthroplasty (TKA) to improve their quality of life. Outcomes of 20 primary total joint arthroplasties (15 THA, 5 TKA) in 14 patients with lung transplantation were reviewed. Clinical follow-up time averaged 27.5 and 42.8months for THA and TKA respectively. Arthroplasty indications included osteonecrosis, osteoarthritis, and fracture. All patients subjectively reported good or excellent outcomes with a final average Harris Hip Score of 88.7, Knee Society objective and functional score of 92.0. There were 4 minor and 1 major acute perioperative complications. 1 late TKA infection was successfully treated with two-stage revision. The mortality rate was 28.5% (4/14 patients) at an average 20.6months following but unrelated to arthroplasty. Overall, total joint arthroplasty can be safely performed and provide good functional outcomes in lung transplant recipients.The Journal of arthroplasty 04/2013; 29(1). DOI:10.1016/j.arth.2013.03.029 · 2.37 Impact Factor