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Late complications after total hip replacement in renal allograft recipients

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Summary

Seventy nine hips in 53 recipients of renal allografts were treated by cemented total hip replacement for avascular necrosis of the femoral head between 1972 and 1992. Eight hips in 6 patients required revision for aseptic loosening after a mean of 11.2 years. Three replacements in 3 patients became infected with salmonella enteritidis after a mean of 6.2 years. One was revised, one had a disarticulation of the hip, and the third was treated with long term antibiotics. Survivorship analysis for total hip replacement and the renal allografts showed a hip reoperation rate of 9.9% at 10 years and 54.6% at 15 years with mortality rates of 32.2% and 42.2% respectively. Thus patients surviving 15 years are at a higher risk of failure of the prostheses than of dying.

Résumé

Cinquante six transplantés rénaux (TR) ont été traités par arthroplastie totale de hanche (ATH) pour nécrose aseptique de la tête fémorale (NA), de 1972 à 1992 (recul moyen 6.9 ans). Huit hanches (10.1%) chez 6 patients (11.3%) ont dû être réopérées pour descellement aseptique après un délai moyen de 11.2 ans. Trois patients ont présenté une arthrite septique à Salmonella enteritidis, 6.2 ans en moyenne après l'intervention. Un des trois patients a été traité par révision de l'arthroplastie, le deuxième par une dèsarticulation de hanche en raison d'un risque vital et le troisième par antibiothérapie. Deux fois sur les trois, l'examen bactériologique des urines a révélé la présence de salmonelles. L'analyse des courbes de survie en cas d'ATH et de TR montre un risque de réintervention sur la hanche de 9.9% à dix ans et de 54.6% à quinze ans et un risque de mortalité de 32.2% à dix ans et de 42.2% à quinze ans. Donc les patients qui survivent quinze ans ont plus de risque de voir leur prothèse se desceller que de mourir. L'espérance de vie pour TR n'ayant cessé d'augmenter grâce à l'amélioration des traitements immuno-suppresseurs, les prothèses non-cimentées peuvent représenter une alternative intéressante pour ces jeunes patients, même s'ils souffrent d'une ostéopathie rénale et d'une ostéoporose par corticothérapie.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, University of Zürich, Switzerland

    J. Romero & A. Schreiber

  2. Department of Internal Medicine, School of Medicine, University of Zürich, Switzerland

    U. Binswanger

Authors
  1. J. Romero
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  2. A. Schreiber
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  3. U. Binswanger
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Romero, J., Schreiber, A. & Binswanger, U. Late complications after total hip replacement in renal allograft recipients. International Orthopaedics 18, 368–371 (1994). https://doi.org/10.1007/BF00187084

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