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

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 diagnosed with femoral head osteonecrosis subchondral collapse underwent staged cementless total arthroplasties. re-presented progressive right knee pain. Investigations revealed diaphyseal a rare intra-articular bicondylar distal femur extension without evidence collapse. To date, this has been monitored conservatively managed.Conclusion: Osteonecrosis in long term transplant survivors is cause significant morbidity, the potential progressive, multifocal lesions.