Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study
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ORIGINAL PAPER
Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study Yoshitoshi Higuchi 1 & Toshihide Tomosugi 2 & Kenta Futamura 2 & Manabu Okada 2 & Shunji Narumi 2 & Yoshihiko Watarai 2 & Yoshitaka Suzuki 1 & Norihiko Goto 2 & Toshihiro Ando 1 & Koji Sato 1 Received: 19 May 2020 / Accepted: 17 June 2020 # SICOT aisbl 2020
Abstract Background There is a lack of evidence about the risk factors associated with osteonecrosis of the femoral head (ONFH). Purposes To determine the incidence and risk factors for ONFH following renal transplantation (RT). Methods In total, data of 681 RT patients (mean age at surgery, 49.5 ± 13.6 years; 249 women and 432 men) were evaluated to determine the incidence of ONFH. Hip magnetic resonance imaging (MRI) was performed six months after RT. The following potential predictors of ONFH were evaluated: (1) patient’s condition at RT; laboratory test results including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone before RT; blood relationship between the patient and donor; and mismatching number of human leukocyte antigens (HLAs), especially HLA class I and class II and (2) dosages of steroids after RT, immunosuppressive regimen, and incidence of acute rejection. Results ONFH was observed in 30 hips (21 cases, 3.1%). We successfully matched 63 patients without ONFH. Multivariate logistic regression analysis, adjusted for cumulative dosages of steroids, revealed that mismatching number of HLA (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10–2.36; p = 0.014), HLA class II (HR, 3.73; 95% CI, 1.46–9.56; p = 0.001), P before RT (HR, 1.62; 95% CI, 1.02–2.58; p = 0.041), and Ca × P before RT (HR, 1.06; 95% CI, 1.01–1.11; p = 0.024) were risk factors for ONFH. Conclusion A greater number of HLA mismatches, HLA class II, serum P, and serum Ca × P were risk factors for ONFH after RT. Therefore, these factors should be evaluated in order to predict ONFH after RT. Keywords Osteonecrosis of the femoral head . Renal transplant . Risk factor . Magnetic resonance imaging
Introduction Osteonecrosis of the femoral head (ONFH) is well recognised as a musculoskeletal complication after renal transplantation (RT) [1–3]. ONFH is almost always a serious complication, which leads to considerable restriction in the function of the individual and eventual disability, ultimately causing femoral collapse that requires total hip arthroplasty [4]. Glucocorticoids
* Yoshitoshi Higuchi [email protected] 1
Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myouken-cho Showa-ku, Nagoya 466-8650, Japan
2
Department of Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
are considered to contribute to ONFH after RT [4]. With advances in immunosuppressive therapy, reduced doses of corticosteroids are reported to have led to a decrease in the incidence of ONFH. However, recent studies using magnetic resonance imaging (MRI) reported t
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