Osteonecrosis in the transplant recipient.

From 1969 to 31 March 1982, 1,769 organ transplants were performed by the University of Minnesota Transplant Service. Fifty-one patients had severe osteonecrosis develop requiring 83 total joint arthroplasties. Patients with diabetes were underrepresented in the arthroplasty population; this may be due to neuropathy masking some disease. All of the patients received dramatic relief from pain and experienced improved function. Only one surgical mortality occurred--a patient with sepsis. To minimize complications, prophylactic antibiotics were used, and most patients did not undergo prophylactic anticoagulation. The most common complication was dislocation of the hip, at five to eight times the rate of those in the nontransplant arthroplasty population. These can be minimized by avoiding the posterior lateral surgical approach and by meticulous capsular repair. Despite the youth and activity of these patients, component wear was not a problem. However, because of the multicentric nature of this disease, components and surgical approach should be chosen carefully. Incidence of severe osteonecrosis was highest among cadaver kidney recipients. No HLA identical kidney recipient had severe osteonecrosis develop. Consequently, we concur with previous authors that osteonecrosis may be caused by the higher dosages of immunosuppressive agents required to prevent rejection of HLA nonidentical organs.