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. 2008 Feb;466(2):287-93.
doi: 10.1007/s11999-007-0044-z. Epub 2008 Jan 10.

Osteonecrosis after allogeneic bone marrow transplantation

Frederic Zadegan  1 , Agnes Raould, Pascal Bizot, Remy Nizard, Laurent Sedel
Affiliations

Osteonecrosis after allogeneic bone marrow transplantation

Frederic Zadegan et al. Clin Orthop Relat Res. 2008 Feb.

Abstract

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.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–C
Fig. 1A–C
A 13-year-old boy with severe graft-versus-host disease (A) with bilateral hip involvement (B) underwent hip arthroplasty. (C) The aspect of the left femoral head at surgery is shown.
Fig. 2A–D
Fig. 2A–D
A 28-year-old man with bilateral involvement was operated on the (A) right side 17 years ago and on the (B) left side 12 years ago. (C) Aseptic loosening of the right socket occurred after 16 years and (D) revision surgery was performed.
Fig. 3
Fig. 3
Considering loosening of any component (aseptic or septic) as the end point, the survivorship rate was 74.8% (range, 58.7%–90.9%) at 10 years.
Fig. 4
Fig. 4
The specific impacted and cemented plain alumina cup (CERAPRESS®) survivorship with loosening as the end point was 78.6% (range, 61.6%–95.6%) at 10 years.
Fig. 5
Fig. 5
The specific metal back press fit cup (Cerafit®) survival was 100% at 5 years. The survival of the specific cemented stem was 88.9% (range, 78.3%–99.5%) at 10 years.
Fig. 6A–B
Fig. 6A–B
Radiographic aspects (A) preoperatively and (B) 10 years after one-stage bilateral hip prosthesis implantation are shown. The patient can run, is pain-free, and has full range of motion.
See this image and copyright information in PMC

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