EARLY DETECTION OF AVASCULAR NECROSIS OF THE FEMORAL-HEAD FOLLOWING RENAL-TRANSPLANTATION

This prospective study included 43 patients undergoing renal transplan tations. Magnetic resonance imaging (MRI) and X-rays of the hip joints were produced 3 and 12 months after transplantation. In 6 hip joints of 4 patients (9.3%), we discovered femoral head necroses just 3 month s after transplantation. Three of the hip joints affected were symptom atic and 3 painless. The MR images taken 12 months after transplantati on revealed no additional femoral head necrosis. A core decompression was performed on 3 joints. In contrast to those with core decompressio n, the femoral heads without core decompression showed a progression o f the necrosis in 2 of 3 cases. All 4 patients with femoral head necro ses were younger than 50 years and exhibited a premature conversion of the haematopoietic marrow to fatty marrow in the area of the proximal femoral metaphysis. A similar premature conversion to fatty marrow wa s seen in 6 of the 22 (27.2%) patients younger than 50 years and witho ut femoral head necroses. The doses in long-term steroid medication an d the steroid doses during the rejection periods of the patients with femoral head necroses were not significantly higher than those for the patients with premature conversion to fatty marrow. The latter had al so not received significantly higher doses than the patients whose MRI findings were inconspicuous.