title: Symptomatic osteonecrosis of the hip and knee after cardiac transplantation.
abstract: Patients who are treated with steroids for immunosuppression after solid organ transplant are at risk for development of osteonecrosis. The purpose of this study was to determine the prevalence of symptomatic osteonecrosis of the hip and knee in patients who were treated with corticosteroids after cardiac transplantation and to determine if there was a relationship between steroid dose and the development of osteonecrosis. We retrospectively evaluated 204 patients who underwent cardiac transplantation and noted that only 6 (3%) of 204 patients developed symptomatic osteonecrosis of the hip or knee. The osteonecrosis was diagnosed an average of 38.5 months (range, 21-52 months) after transplantation. There was no association noted between steroid dose and the development of symptomatic osteonecrosis. The low prevalence of osteonecrosis supports the hypothesis that the development of osteonecrosis in these patients is an idiosyncratic response to steroids, perhaps related to an underlying hypercoagulable state or hypofibrinolysis.
authors.affiliation: The Musculoskeletal Institute and the Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030-5456, USA.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Lieberman
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Roth
authors.forename: Peter
authors.initials: P
authors.lastname: Elsissy
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000453:epidemiology*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007719:Knee Joint; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone