J Korean Hip Soc.  2011 Mar;23(1):72-78. 10.5371/jkhs.2011.23.1.72.

Total Hip Arthroplasty in Patient with Osteonecrosis of the Femoral Head Following Liver Transplantation: Case Report

• Park YH
• Yoon TR
• Park KS
• Shin YJ

• KMID: 2190779
• DOI: http://doi.org/10.5371/jkhs.2011.23.1.72

Abstract

Liver transplantation has improved the survival of patients with end stage liver disease. As the rates of success of liver transplantation continue to increase, more patients who have a liver transplant will become candidates for joint replacement due to osteonecrosis. The incidence of osteonecrosis has been variously reported as from 2% to 8.2% after liver transplantation. However, there are only three reports in the English medical literature about total hip arthroplasty for osteonecrosis of the femoral head following liver transplantation, and especially there has not been such a report from Asian countries. We report here on two patients with transplanted livers and who then underwent total hip arthroplasty.

Keyword

Hip; Total hip arthroplasty; Femoral head osteonecrosis; Liver transplantation

MeSH Terms

Arthroplasty
Asian Continental Ancestry Group
End Stage Liver Disease
Head
Hip
Humans
Incidence
Joints
Liver
Liver Transplantation
Osteonecrosis
Transplants

Figure

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  Fig. 1 Preoperative radiologic evalulation of the first case. (A, B) Anteroposterior and lateral radiographs of pelvis showing a subchondral sclerosis and femoral head collapse. (C, D) MRI shows the double line sign on right femoral head at T2 weighted coronal view and the hyperintense signal change of right femoral head at T2 weighted axial view.

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  Fig. 2 Radiologic evaluation of the first case at last follow up. (A, B) Postoperative 35-month anteroposterior and lateral radiographs of pelvis showing stable bony ingrowth without radiolucent lines or migration.

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  Fig. 3 Preoperative radiologic evalulation of the second case. (A, B) Anteroposterior and lateral radiographs of pelvis showing a subchondral sclerosis and femoral head collapse. (C, D) MRI shows hypointensie signal change of left femoral head at T2 weighted coronal and axial view.

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  Fig. 4 Radiologic evaluation of the second case at last follow up. (A, B) Postoperative 12-month anteroposterior and lateral radiographs of pelvis showing good alignment.

Reference

1. Taillandier J, Alemanni M, Samuel D, Bismuth H. Rheumatic complications following liver transplantation. Transplant Proc. 1999. 31:1717–1718.

2. Porayko MK, Wiesner RH, Hay JE, et al. Bone disease in liver transplant recipients: incidence, timing, and risk factors. Transplant Proc. 1991. 23:1462–1465.

3. Tannenbaum DA, Matthews LS, Grady-Benson JC. Infection around joint replacements in patients who have a renal or liver transplantation. J Bone Joint Surg Am. 1997. 79:36–43.

4. Hamburg SM, Piers DA, van den Berg AP, Slooff MJ, Haagsma EB. Bone mineral density in the long term after liver transplantation. Osteoporos Int. 2000. 11:600–606.

5. Mehrabi A, Fonouni H, Müller SA, Schmidt J. Current concepts in transplant surgery: liver transplantation today. Langenbecks Arch Surg. 2008. 393:245–260.

6. Lee SG. Current status of liver transplantation in Korea. Korean J Gastroenterol. 2005. 46:75–83.

7. Papagelopoulos PJ, Hay JE, Galanis EC, Morrey BF. Total joint arthroplasty in orthotopic liver transplant recipients. J Arthroplasty. 1996. 11:889–892.

8. Levitsky J, Te HS, Cohen SM. The safety and outcome of joint replacement surgery in liver transplant recipients. Liver Transpl. 2003. 9:373–376.

9. Lieberman JR, Scaduto AA, Wellmeyer E. Symptomatic osteonecrosis of the hip after orthotopic liver transplantation. J Arthroplasty. 2000. 15:767–771.

10. Goffin E, Baertz G, Rombouts JJ. Long-term survivorship analysis of cemented total hip replacement (THR) after avascular necrosis of the femoral head in renal transplant recipients. Nephrol Dial Transplant. 2006. 21:784–788.