Osteonecrosis after allogeneic bone marrow transplantation.
Osteonecrosis after bone marrow transplantation is usually severe. Most patients develop acute and chronic graft-versus-host disease requiring a high dose of steroids for a long period of time. Generally ineffective nonoperative treatment in the past has resulted in treatment primarily with total hip arthroplasty (THA). We asked whether THA (1) reliably improved functional status, (2) led to more complications, and (3) THA after bone marrow transplantation was as durable as THA for idiopathic ON. We retrospectively reviewed 77 patients (123 hips) with osteonecrosis. The mean age at surgery was 33 years (range, 15.7-56 years). We performed all arthroplasties with an alumina ceramic bearing coupled with an alumina head 32 mm in diameter. The minimum followup was 2 years (mean, 9.2 years; range, 2-26 years). We documented seven revisions: three for late septic loosening, four for late aseptic loosening. Considering loosening of any component as the end point, the survivorship was 74.8% (range, 58.7%-90.9%) at 10 years. In this difficult situation, we believe the results acceptable. Septic loosening affecting this specific population has to be considered a serious event.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Zadegan
Frederic
F
Department of Orthopaedic Surgery, Lariboisière Hospital, 2, rue A Paré, 75010 Paris, France. fzadegan@gmail.com
Raould
Agnes
A
Bizot
Pascal
P
Nizard
Remy
R
Sedel
Laurent
L
D000293:Adolescent; D000328:Adult; D000537:Aluminum Oxide; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D011475:Prosthesis Failure; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects; D014184:Transplantation, Homologous
D013256:Steroids; D000537:Aluminum Oxide