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Femoral head osteonecrosis after bone marrow transplantation
1Department of Traumatology and Orthopaedic Surgery, Hôpital Lariboisière, Paris, France.
Clinical Orthopaedics and Related Research
|January 26, 1999
Summary
Osteonecrosis of the femoral head after bone marrow transplant often leads to hip collapse and requires surgery. Femoral head survival rates are low, suggesting early total hip replacement may be beneficial after medical treatment failure.
Area of Science:
- Orthopedics
- Hematology
- Transplantation Medicine
Background:
- Osteonecrosis of the femoral head (ONFH) is a known complication following bone marrow transplantation (BMT).
- Patients undergoing BMT often present with bilateral hip involvement, leading to significant morbidity.
Purpose of the Study:
- To retrospectively review patients with bilateral ONFH post-BMT.
- To evaluate the long-term outcomes and treatment efficacy for ONFH following BMT.
Main Methods:
- Retrospective review of 35 patients with bilateral ONFH after BMT.
- Analysis of symptom onset, radiographic progression, and surgical interventions.
- Assessment of femoral head survival rates based on treatment outcomes.
Main Results:
- First symptoms appeared within 2 years post-transplant, with high rates of hip pain, radiographic lesions, and collapse at presentation and follow-up.
- A significant majority of hips (57/70) required surgical intervention, predominantly primary total hip replacement.
- Femoral head survival rate was 30% at 5 years post-transplant when total hip replacement was considered treatment failure.
Conclusions:
- ONFH following BMT is a progressive condition with poor long-term outcomes for the native femoral head.
- Conservative management has limited success, with high rates of surgical conversion.
- Primary total hip arthroplasty may be a viable option after failure of medical treatment for ONFH post-BMT.