Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
J Orthop Sci. 2022 Mar;27(2):395-401. doi: 10.1016/j.jos.2020.12.014. Epub 2021 Feb 26.
Corticosteroids are essential for immunosuppression after orthotopic liver transplantation (OLT), but also have many side effects. Osteonecrosis of the femoral head (ONFH) is one of the most serious complications requiring prostheses. However, few studies have investigated ONFH after OLT. The purpose of this study is to survey the incidence of corticosteroid-induced ONFH after OLT and the outcomes of total hip arthroplasty (THA).
Between January 2001 and December 2010, a series of 926 patients underwent OLT at our Hospital. A retrospective analysis was performed on a total of 738 patients who survived at least 2 years after OLT. The incidence of symptomatic ONFH, the interval from OLT to the initial diagnosis of ONFH, and the cumulative dose of corticosteroids were analyzed. The side effects related to OLT, such as other osteonecrosis lesions, osteoporotic fractures, and infection, were monitored. For patients who underwent THA, radiological findings and Japanese Orthopaedic Association (JOA) scores were evaluated.
ONFH occurred in 10 patients (13 hips) (6 men [7 hips], 4 women [6 hips]), with an incidence of 1.36%. The average age at OLT was 51.4 years (range, 31-61 years). The average interval from OLT to ONFH was 86.7 months (range, 22-155 months). The average cumulative dose of corticosteroids was 7274 mg (range, 1342-29,514 mg). Twenty patients suffered from side effects related to OLT. Seven patients (8 hips) underwent THA. No adverse events including infection arose during the perioperative process. One hip dislocated, and one femoral stem displayed a radiolucent line. The average JOA score improved from 45.4 (range, 25-76) preoperatively to 86.9 (range, 73-99) at final follow-up. No patients required revision surgery.
The incidence of symptomatic ONFH after OLT was 1.36%. Once the graft function becomes stable, THA can be a safe and effective treatment option for patients with ONFH after OLT.
皮质类固醇在肝移植（OLT）后免疫抑制中是必不可少的，但也有许多副作用。股骨头坏死（ONFH）是需要假体治疗的最严重并发症之一。然而，很少有研究调查 OLT 后的 ONFH。本研究的目的是调查 OLT 后皮质类固醇诱导的 ONFH 的发生率和全髋关节置换术（THA）的结果。
2001 年 1 月至 2010 年 12 月期间，我院共对 926 例患者进行了 OLT。对 738 例至少在 OLT 后存活 2 年的患者进行了回顾性分析。分析了症状性 ONFH 的发生率、OLT 至 ONFH 初诊的间隔时间以及皮质类固醇的累积剂量。监测了与 OLT 相关的副作用，如其他骨坏死病变、骨质疏松性骨折和感染。对于接受 THA 的患者，评估了影像学发现和日本骨科协会（JOA）评分。
10 例（13 髋）（6 例男性[7 髋]，4 例女性[6 髋]）发生 ONFH，发生率为 1.36%。OLT 时的平均年龄为 51.4 岁（范围 31-61 岁）。OLT 至 ONFH 的平均间隔时间为 86.7 个月（范围 22-155 个月）。皮质类固醇的平均累积剂量为 7274mg（范围 1342-29514mg）。20 例患者发生与 OLT 相关的副作用。7 例（8 髋）行 THA。围手术期无感染等不良事件发生。1 髋脱位，1 例股骨柄显示透亮线。JOA 评分从术前的 45.4（范围 25-76）平均提高到末次随访时的 86.9（范围 73-99）。无患者需要翻修手术。
OLT 后症状性 ONFH 的发生率为 1.36%。一旦移植物功能稳定，THA 可以成为OLT 后 ONFH 患者安全有效的治疗选择。
