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Orthopaedic complications following cardiac transplantation
B Egan1, J M O'Byrne, D O'Farrell
1Dept. of Cardiac Surgery, Mater Hospital, Dublin.
Insights
Orthopaedic complications are common in heart transplant recipients, with avascular necrosis of the hip being a significant risk, especially with high-dose steroid use for rejection. Treatment requires special considerations for this patient population.
Area of Science:
- Orthopaedic Surgery
- Transplant Medicine
- Rheumatology
Background:
- Cardiac transplantation is a primary treatment for end-stage heart disease.
- Orthopaedic surgeons increasingly manage bone and soft tissue issues in transplant patients.
- A six-year study at Mater Hospital reviewed 46 heart transplant patients.
Purpose of the Study:
- To describe the presentation, investigation, and management of orthopaedic complications in heart transplant recipients.
- To highlight specific challenges and modifications needed for treating these patients.
Main Methods:
- Retrospective review of 46 heart transplant patients over six years.
- Analysis of orthopaedic complications, patient demographics, and treatment regimens.
- Identification of risk factors and specific management considerations.
Main Results:
- Nine patients (20%) experienced 13 orthopaedic complications.
- Common complications included avascular necrosis of the hip (AVN), soft tissue infections, osteoporosis, and stress fractures.
- High-dose steroid use for rejection episodes was associated with bony complications, particularly AVN of the hip.
Conclusions:
- Heart transplant recipients are at risk for various orthopaedic complications.
- Management requires tailored approaches, including avoiding certain medications like Erythromycin.
- Increased risk of AVN of the hip necessitates careful monitoring in patients on high-dose steroids.
Abstract:
Cardiac transplantation has become the treatment of choice for end stage heart disease. In 1990 2,000 transplants were performed worldwide. Orthopaedic Surgeons will be asked with increasing frequency to evaluate and treat bone and soft tissue problems with these patients. Orthopaedic service at the Mater Hospital has been involved in the follow-up treatment of orthopaedic complications in 46 transplant patients over a six year period. Thirty eight were male and eight were female. The ages were between 12 years and 65 years (mean 44.3). Nine (20%) of these patients developed thirteen orthopaedic complications: A vascular Necrosis of the hip (AVN) (4), Soft tissue infections (3), Osteoporosis (2), Stress Fractures (2), Osteomyelitis (1) and Ostomalacia (1). The mode of presentation, investigation and management of orthopaedic problems particular to these patients is described. Most patients who develop bony complications have had increased doses of steroids for episodes of rejection. This study highlights the special features of this patient population that require modification of the treatment approach such as the need to avoid the drug Erythromycin and the increased risk of AVN of the hip in patients who require high dose steroids.