[Aseptic osteonecrosis in the renal transplant patient. Apropos of 27 surgically treated cases]

Abstract

The authors have treated 27 cases of avascular necrosis of bone in patients following renal transplantation. They have noted some specific features--early onset after transplantation, multiple localization and rapid and severe progress of the lesion. The authors discuss the pathogenesis as it relates to cortico-steroids, bone dystrophy due to renal failure and the effects of dialysis. Surgical treatment requires special care because of the poor general condition of the patient. Operations have been done on 20 hips (12 forages, 1 cup arthroplasty, 2 Moore prostheses, 5 total prostheses) and 7 knees (1 forage, 6 removal of loose bodies). Two procedures were found to be valuable at the hip--forage at a very early stage and total prosthetic replacement. The indications for operation depend on the degree of functional disability. For the knee, necrosis affected both the femoral and tibial component resulting in effusion and locking. The only useful procedure seemed to be removal of loose bodies. In every case, surgical procedures must be conducted under careful and constant medical supervision.