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Total hip arthroplasty in the cardiac transplant patient
Insights
Cardiac transplant recipients may develop osteonecrosis of the femoral head, requiring hip replacement. This condition is linked to immunosuppression, likely from steroid use, similar to kidney transplant patients.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Immunology
Background:
- Osteonecrosis of the femoral head is a known complication after organ transplantation.
- Immunosuppressive therapy, particularly corticosteroids, is implicated in its pathogenesis.
Observation:
- Two patients who underwent cardiac transplantation developed osteonecrosis of the femoral head.
- Both patients required bilateral total hip arthroplasties.
- Clinical courses and rejection episodes were monitored.
Findings:
- Pathological changes in the femoral heads were consistent with immunosuppression-induced osteonecrosis.
- The mechanism appears similar to that observed in renal transplant recipients.
- Successful total hip arthroplasty was achieved in these cardiac transplant patients.
Implications:
- Cardiac transplant recipients are at risk for femoral head osteonecrosis.
- Immunosuppression management, especially steroid dosage, is crucial.
- Total hip arthroplasty is a viable treatment option with careful anesthetic management.
Abstract:
Osteonecrosis of the femoral head following cardiac transplantation has led to bilateral total hip arthroplasties in 2 patients. The clinical course and rejections of these patients are outlined. The pathological changes in the femoral heads suggested that the process leading to osteonecrosis in the cardiac transplant patient is the same as that following renal transplantation, both being due to immunosuppression probably related to steroid dosage. Successful joint replacement can be carried out in the cardiac transplant with careful monitoring of anesthesia. Both patients have done well, being followed for 14 and 6 months respectively.