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Osteonecrosis in the transplant recipient.

D S Bradford, E W Szalapski, D E Sutherland

    Surgery, Gynecology & Obstetrics
    |October 1, 1984
    PubMed
    Summary

    Organ transplant patients undergoing joint replacement surgery experienced significant pain relief and improved function. However, hip dislocation was a common complication, particularly in kidney transplant recipients, suggesting a link to immunosuppressive drug dosages.

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    Area of Science:

    • Orthopedic Surgery
    • Transplant Medicine
    • Immunology

    Background:

    • Organ transplantation, particularly kidney transplants, can lead to severe osteonecrosis.
    • Osteonecrosis often necessitates total joint arthroplasty in transplant recipients.
    • Understanding complications and outcomes in this patient population is crucial.

    Purpose of the Study:

    • To analyze the outcomes of total joint arthroplasties in organ transplant recipients.
    • To identify risk factors and complications associated with osteonecrosis in this cohort.
    • To provide recommendations for optimizing surgical approaches and implant selection.

    Main Methods:

    • Retrospective review of 1,769 organ transplants performed between 1969 and 1982.
    • Analysis of 83 total joint arthroplasties performed in 51 patients due to severe osteonecrosis.
    • Comparison of complication rates with the general arthroplasty population.

    Main Results:

    • All patients reported significant pain relief and improved function post-arthroplasty.
    • The most frequent complication was hip dislocation, occurring at a much higher rate than in non-transplant patients.
    • Osteonecrosis incidence was highest in cadaver kidney recipients, with no cases in HLA identical kidney recipients.
    • Higher immunosuppressive agent dosages for non-identical organs may contribute to osteonecrosis.

    Conclusions:

    • Total joint arthroplasty offers substantial benefits for transplant recipients with osteonecrosis.
    • Minimizing hip dislocation risk involves avoiding posterior-lateral approaches and ensuring meticulous capsular repair.
    • Careful selection of components and surgical techniques is vital due to the disease's multicentric nature and patient activity levels.
    • Immunosuppression protocols, especially for non-identical organ transplants, warrant careful consideration regarding osteonecrosis risk.

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