Cementless total hip arthroplasty in renal transplant patients

We present our experience of contemporary cementless total hip arthroplasty (THA) conducted at a single institution to treat advanced avascular necrosis (AVN) in renal transplant patients. Between October 1997 and October 2008, 45 consecutive primary cementless THAs were performed in 30 patients with advanced AVN after renal transplantation. There were 18 males (27 hips) and 12 females (18 hips) (patient group) with an overall mean age 44 years (22 to 68). The clinical and radiographic results were compared with those of 96 sex and age-matched osteonecrotic hips in 72 patients that had not undergone organ transplantation or long-term steroid therapy (the control group). Patients were evaluated at surgery and at a mean of 7.2 years (2 to 13 years) postoperatively. The mean Harris hip score of patients improved from 48 points preoperatively to 94 points at last follow-up (p<0.05). Three hips in the patient group had massive osteolysis with polyethylene wear requiring revision surgery. One hip in the patient group underwent revision surgery because of recurrent dislocation at 11 years postoperatively. No intergroup differences in overall rates of complications or revisions were observed. However, transplant patients had a significantly higher rate of ectopic ossification. Despite diffuse osteopenia and chronic immunosuppression in renal transplant patients with osteonecrotic hips, cementless THA showed durable implant fixation to bone and no increased risk of complications.