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The incidence of AVN has been reported at 4% to more than 10%. The mean time from transplant to the diagnosis of AVN is 18 months, and joint pain is usually the first sign [37–40]. The hip joint is affected in more than 80% of cases with bilateral involvement occurring in more than 60% of cases. Other locations described include the knee (10% of patient with AVN), wrist and ankle. Symptomatic relief of pain and orthopedic measures to decrease the pressure on the affected joints are of value, but most adult patients with advanced damage will require surgery. By 5 years, about 80% of patients will have undergone total hip replacement. Short‐term results of joint replacement are excellent in more than >85%, but further long term follow‐up is required, particularly in young patients, to determine outcome over an extended life span [41]. Steroid use (both total dose and duration) is the strongest risk factor for AVN [37‐41,42].