Aseptic Hip Necrosis After Renal Transplantation

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Abstract
• To help determine the etiology of posttransplant aseptic hip necrosis, 11 stable renal allograft recipients (group A) who developed aseptic hip necrosis were compared with 89 patients (group B) without this complication. A comparison of mean age, duration of dialysis, mean daily prednisone dose, and incidence of rejection in the first year following transplant, sex, donor source, incidence of posttransplant parathyroidectomy, and mean serum calcium and alkaline phosphatase levels identified no significant differences between groups A and B. The mean serum creatinine value at three (2.2± 0.31 mg/dL [190±30 μmol/L] vs 1.9±0.10 mg/dL [170±10 μmol/L]) and 12 (2.3±0.35 mg/dL [200±30 μmol/L] vs 1.9±0.10 mg/dL [170±10 μmol/L]) months and the serum phosphate value at three (3.0±0.19 mg/dL [0.97±0.06 mmol/L] vs 2.8±0.08 mg/dL [0.90±0.03 mmol/L]) and six (3.2±0.25 mg/dL [1.03±0.08 mmol/L] vs 2.9± 0.25 mg/dL [0.94± 0.08 mmol/L]) months were significantly greater in group A. Eight patients in group A underwent 13 total hip replacements an average of 16.5±3.1 months following transplant without significant complications. In conclusion, posttransplant aseptic hip necrosis occurs frequently, and renal allograft dysfunction may contribute significantly to its pathogenesis. When indicated, total hip replacement is both safe and effective. (Arch Surg1986;121:803-805)