Total Hip Arthroplasty for Osteonecrosis of the Femoral Head Following Cardiac Transplantation - A Case Report -

Abstract

Cardiac transplantation is the only therapy available for terminal heart failure, and was pioneered by Christian Barnard in the 1970’s, who also conducted the first heart transplant in 1976, although unfortunately this patient expired 18 days after surgery. However, subsequently, many immunosuppressive agents and operation techniques were developed. In particular, the increased survival rates being achieved today can be attributed to a number of factors, such as, the refinement of medical and surgical techniques, better patient selection criteria, improved myocardial preservation, and the judicious use of cyclosporine, a selective T-cell immunosuppressant. Today more than 2000 heart transplants are performed annually, and in 2008 Roussel et al. reported survival rates after 5, 10, and 15 year postop of 75, 58, and 42%, respectively. In the Republic of Korea, the first cardiac transplantation was performed at 1992, and in the 2008 the summed total number of cases performed stood at 434; 20~30 cases were performed annually until 2006 but this increased to 50 cases in 2007 and to 84 cases in 2008. On the other hand, orthopaedic complications, such as osteopenia, osteoporosis, fractures, and osteonecrosis are also increasing in parallel with survival rates and the use of immunosuppressants. In particular, the incidence of osteonecrosis of the femoral head has been reported to be 2~3%. This condition has been well documented after renal transplantation, but few reports have addressed osteonecrosis following cardiac transplantation, although it was been first reported by Danzig, et al. as long ago as 1976. Submitted: November 4, 2009 1st revision: February 11, 2010 2nd revision: February 24, 2010 3nd revision: June 14, 2010 Final acceptance: June 14, 2010