Hip arthropathy in long-term (20 years or more) hemodialysis patients

Purpose. The purpose of this study was to report the hip joint radiographic findings in 18 patients who had been undergoing hemodialysis (HD) for 20 years or more. Materials and Methods. Ten male and 8 female patients from the outpatient clinic of our institution who had been on maintenance HD for 20 years or more were enrolled in this study. At the time of the investigation, the mean patient age was 56 years, and the mean HD duration was 286 months. Radiographs of the hip joint were evaluated for the presence of bone cysts and joint space narrowing. Bone mineral density (BMD) was measured at the distal one-third of the radius by dual-energy x-ray absorptiometry. Serum levels of total calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), intact parathyroid hormone (PTH), and beta-2-microglobulin (BMG) also were measured. Results. Bone cysts were found in 12 patients (67%), and joint space narrowing was found in 4 patients (22%). The radiographic abnormalities frequently were bilateral both for bone cysts (82%) and joint space narrowing (92 %). The mean BMD was 0.462 g/cm(2). The mean values of Ca, P, ALP, PTH, and BMG were 4.4 mEq/L, 6.7 mg/dl, 294.1 IU/L, 12.9 pg/ml, and 39.2 mug/ml, respectively. BMG was significantly high, with other values being within normal limits. Hip arthroplasties were performed in 6 patients (33 %) suffering either from femoral neck fracture associated with bone cysts (4 patients) or joint space narrowing (2 patients). All 4 of the femoral neck fracture patients showed marked bone loss (mean BMD, 0.371 g/cm(2)). Conclusions. Sixteen of 18 patients (89 %) showed hip joint alterations such as bone cysts and joint space narrowing. Attention should be paid to preventive treatment measures for hip arthropathy in long-term HD patients.