Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients

Ten cardiac transplant patients have had bilateral total hip or knee surgery for treatment of osteonecrosis secondary to corticosteroid immunosuppression. Nine had bilateral total hip arthroplasty and one had bilateral total knee arthroplasty for osteonecrosis of the tibial plateaus. The only immediate postoperative complication was in a single hip patient who had a nonfatal pulmonary embolism. Two patients died from cardiovascular causes; the remaining eight had excellent results from arthroplasty, with an average Harris hip rating of 95 at a mean follow-up period of 34 months. No patient had required revision surgery and radiographic follow-up examination has revealed no evidence of loosening of any of these cemented arthroplasties. One patient developed a late hematogeneous sepsis of one hip seven years after replacement from atypical mycobacterium three months following renal transplantation, which was done 11 years after cardiac transplantation. Total joint arthroplasty has resulted in excellent clinical and radiologic results in this patient population. Despite the increased risks of major surgery in these immunocompromised transplant recipients, total joint arthroplasty appears to be a safe and effective method of treatment of osteonecrosis of the hip.