Post-transplant femoral head avascular necrosis: a selective investigation with MRI
Levent Karapinar1, Alp Gurkan, Serdar Kacar
1Department of Orthopedics and Traumatology, Izmir-Tepecik Training and Research Hospital, Izmir, Turkey. lkarapinar@yahoo.com
Background:
We investigated the presence of femoral head avascular osteonecrosis (FHAVN) by a selective investigation with MRI at follow-up.
Material/Methods:
A total of 331(200 men, 131 women) renal transplants were included. They were transplanted at the mean age of 31.4 (9-63) years. The mean follow-up time of all patients after transplantation was 60.6 (6-233) months, and the mean current age 36.6 (11-66) years. All transplants filled out a questionnaire on musculoskeletal symptoms and underwent a detailed clinical examination. Magnetic resonance imaging was done in cases of hip joint pain in groin, buttock, thigh and knee and in 50 asymptomatic transplants. FHAVN were identified according to Ficat Arlet classification.
Results:
43(13%) patients reported pain without previous trauma. In the clinical examination, limited ranges of motion of the hip were noted in 13 of them. FHAVN was detected in 11 of 43 patients. Disease was bilateral in two of the eleven patients. Of the 662 femoral heads, 43 were associated with hip pain whereas the remaining 619 were asymptomatic. Avascular osteonecrosis was not confirmed in the asymptomatic 100 hips with magnetic resonance imaging.
Conclusions:
A selective investigation of FHAVN may be used to diagnose in renal allograft recipients with painful hips at follow-up. With a retrospective selective analysis, the presence of FHAVN was low among renal transplantation recipients at the end of the study.
Insights
Selective MRI screening can diagnose femoral head avascular osteonecrosis (FHAVN) in renal transplant recipients experiencing hip pain. This study found a low prevalence of FHAVN in this patient group.
Area of Science:
- Orthopedics
- Nephrology
- Radiology
Background:
- Renal transplant recipients may develop avascular osteonecrosis of the femoral head (FHAVN).
- Investigating FHAVN presence through selective MRI at follow-up is crucial.
Purpose of the Study:
- To determine the prevalence of FHAVN in renal transplant recipients.
- To evaluate the efficacy of selective MRI in diagnosing FHAVN in symptomatic patients.
Main Methods:
- 331 renal transplant recipients underwent clinical examination and questionnaires.
- MRI was selectively performed for hip pain and in asymptomatic controls.
- FHAVN diagnosis followed the Ficat Arlet classification.
Main Results:
- 13% of patients reported hip pain without trauma.
- FHAVN was detected in 11 of 43 symptomatic patients (25.6% of symptomatic cases).
- No FHAVN was confirmed in asymptomatic hips via MRI.
Conclusions:
- Selective MRI is a viable diagnostic tool for FHAVN in renal allograft recipients with hip pain.
- The prevalence of FHAVN is low in renal transplant recipients when investigated selectively.
