Post-transplant femoral head avascular necrosis: a selective investigation with MRI.

ABSTRACT

BACKGROUND: We investigated the presence of femoral head avascular osteonecrosis (FHAVN) by a selective investigation with MRI at follow-up. MATERIAL/METHODS: A total of 331(200 men, 131 women) renal transplants were included. They were transplanted at the mean age of 31.4 (9-63) years. The mean follow-up time of all patients after transplantation was 60.6 (6-233) months, and the mean current age 36.6 (11-66) years. All transplants filled out a questionnaire on musculoskeletal symptoms and underwent a detailed clinical examination. Magnetic resonance imaging was done in cases of hip joint pain in groin, buttock, thigh and knee and in 50 asymptomatic transplants. FHAVN were identified according to Ficat Arlet classification. RESULTS: 43(13%) patients reported pain without previous trauma. In the clinical examination, limited ranges of motion of the hip were noted in 13 of them. FHAVN was detected in 11 of 43 patients. Disease was bilateral in two of the eleven patients. Of the 662 femoral heads, 43 were associated with hip pain whereas the remaining 619 were asymptomatic. Avascular osteonecrosis was not confirmed in the asymptomatic 100 hips with magnetic resonance imaging. CONCLUSIONS: A selective investigation of FHAVN may be used to diagnose in renal allograft recipients with painful hips at follow-up. With a retrospective selective analysis, the presence of FHAVN was low among renal transplantation recipients at the end of the study.