Osteonecrosis after bone marrow transplantation is usually severe. Most patients develop acute and chronic graft-versus-host
disease requiring a high dose of steroids for a long period of time. Generally ineffective nonoperative treatment in the past
has resulted in treatment primarily with total hip arthroplasty (THA). We asked whether THA (1) reliably improved functional
status, (2) led to more complications, and (3) THA after bone marrow transplantation was as durable as THA for idiopathic
ON. We retrospectively reviewed 77 patients (123 hips) with osteonecrosis. The mean age at surgery was 33 years (range, 15.7–56 years).
We performed all arthroplasties with an alumina ceramic bearing coupled with an alumina head 32 mm in diameter. The minimum
followup was 2 years (mean, 9.2 years; range, 2–26 years). We documented seven revisions: three for late septic loosening,
four for late aseptic loosening. Considering loosening of any component as the end point, the survivorship was 74.8% (range,
58.7%–90.9%) at 10 years. In this difficult situation, we believe the results acceptable. Septic loosening affecting this
specific population has to be considered a serious event.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent was obtained.