A rare case of multifocal osteonecrosis of the femur in a heart transplant patient

Abstract

Case: A 58-year-old male was reviewed for bilateral hip pain 3 years post cardiac transplant, complicated by episodes of acute rejection, steroid induced diabetes, and cytomegalovirus hepatitis. He was diagnosed with bilateral femoral head osteonecrosis with subchondral collapse and underwent staged cementless bilateral total hip arthroplasties. He re-presented with progressive right knee pain. Investigations revealed femoral diaphyseal osteonecrosis and a rare intra-articular bicondylar distal femur extension without evidence of collapse. To date, this has been monitored and conservatively managed.Conclusion: Osteonecrosis in long term cardiac transplant survivors is a cause of significant morbidity, with the potential for progressive, multifocal lesions.