title: Avascular necrosis of the femoral head after allogenic bone-marrow transplantation. A retrospective study of 27 consecutive THAs with a minimal two-year follow-up.
abstract: After an allogenic bone-marrow transplant, avascular necrosis of the femoral head may affect young adults, producing destructive lesions which require hip replacement. We have reviewed 27 consecutive such total hip arthroplasties (THA) at a minimal follow-up of two years. Of these, 20 were primary operations for Ficat (1985) stage-III and stage-IV lesions, and seven were revisions after the failure of previous surgery. The median age at operation was 30 years (17.5 to 44). The prostheses had a cemented, collared titanium-alloy stem, an alumina-alumina joint, and a press-fit socket. Seven had a titanium-alloy metal back and 20 had all-alumina cups of which six had to be cemented. At an average follow-up of five years, no patient had been lost to follow-up. One had died from septicaemia after two years and another with chronic graft-versus-host disease developed a deep infection 2.5 years postoperatively and had a successful revision. There were no revisions for aseptic loosening. The clinical results on the Merle d'Aubigné++ and Postel (1954) scale were very good or excellent in 23 hips (88%), good in one and fair in two. Ten hips showed incomplete acetabular radiolucencies less than 1 mm thick, but there were no radiolucent lines around the stems. We conclude that for these difficult patients THA with ceramic joints and careful technique provides the best short- and medium-term option after the failure of medical treatment.
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hôpital Lariboisière, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Bizot
authors.forename: J
authors.initials: J
authors.lastname: Witvoet
authors.forename: L
authors.initials: L
authors.lastname: Sedel
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000601:surgery; D016025:Bone Transplantation; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000379:methods; D006801:Humans; D007938:Leukemia / Q000601:surgery; D008223:Lymphoma / Q000601:surgery; D011183:Postoperative Complications; D011859:Radiography