This advice is given specifically for hip pain but applies to other joint pain occurring following bone marrow transplant (BMT).
Patients having BMT may have had joint pains related to arthritis before they had their transplant. This pain will still be there following BMT. Such arthritis can be treated in a standard fashion, just make sure your rheumatologist and orthopaedic surgeon are aware of the transplant and the drugs you are on.
Following BMT there are three problems that can develop in your hip and it can be difficult to tell them apart:
1. Avascular Necrosis – The drugs you take can interfere with the blood supply to the hip causing a rapidly developing arthritis.
2. Septic Arthritis – This is arthritis caused by infection getting into your hip joint. This will cause rapidly progressive pain. You may not feel unwell to start with, but as infection becomes more advanced you may start to feel unwell. In the early stages it can be difficult to differentiate this from Avascular Necrosis.
3. Graft v Host disease (GvHD) – if you are unfortunate enough to develop GvHD, then this can also lead to either Avascular Necrosis or Septic Arthritis. Additionally it can cause an inflammatory arthritis. It is also difficult to distinguish between these conditions.
The treatment of Septic Arthritis is an emergency, and frequently requires surgery to get rid of the infection. If the diagnosis is delayed this increases the complexity of surgery and how many procedures are required. Because of the urgency of surgery, this will be performed irrespective of your transplant.
Avascular Necrosis, inflammation from GvHD and pre-existing arthritis may require joint replacement surgery. The timing of this will depend on your general health and how well the transplant is doing.
If you develop a new pain around a joint that is not related to an injury and is getting worse over a 24 hour period you should contact the transplant team.
Remember the hip joint is in the groin and hence hip pain is in the front of the leg radiating to the knee. Back pain arises in the back can tends to radiate to the buttock and down the back of the leg.
Investigations to exclude infection should start with a plain x-ray, but frequently will require an MRI scan and then an aspiration of the joint – normally done under X-ray or ultra sound control, where a needle is inserted into the joint with local anaesthetic to aspirate fluid to send to the laboratory.
The diagnosis of infection will result in an emergency referral to orthopaedics. The other diagnoses require less urgent assessment.
Who would give advice or treat joint pain in Leeds?
Mr David MacDonald is usually the Consultant Orthopaedic surgeon that blood and marrow transplant patients are referred to if they are experiencing joint pain. He works for Leeds Teaching Hospitals Trust at Chapel Allerton Hospital.
You should inform the Leeds Blood and Marrow Transplant team if you have any joint problems and if necessary they will refer you to Mr MacDonald. Please do not wait for your appointment as you may need some treatment urgently and waiting may make the problem worse.