Phemister bone graft for osteonecrosis post renal transplant

Avascular necrosis of the femoral head is an unfortunate sequela of renal transplantation. The necessary exogenous steroids are felt to be the cause of the necrosis. The case histories of three patients with bilateral disease are presented. All 6 hips were initially treated with a Phemister bone graft. According to the classification of Marcus, et al., one hip was Stage 3, three hips were Stage 4, and two hips were Stage 5 at the time of grafting. Four of these hips have had minimal further collapse and have been functionally satisfactory for the patients. One femoral head has had marked collapse but is pain free. One femoral head has had marked collapse with pain sufficient to necessitate a total hip replacement. The two heads with marked collapse were both Stage 5 at the time of surgery. The Phemister bone graft is presented as a possible treatment for this problem, especially when the disease is treated before femoral head collapse occurs.