In recent years, the large number of organ transplants has brought new life to many patients with life-threatening conditions, but also created many new medical dilemmas, among which, aseptic necrosis of the femoral head in post-transplant patients is a difficult problem for joint surgeons. Based on the successful hip replacement surgeries for patients after liver and kidney transplantation, the Department of Orthopaedics of our hospital has recently performed total hip replacement and bilateral femoral head decompression implantation for two patients after heart transplantation, bringing new hope for the same patients. When allogeneic organs such as heart, liver, kidney and lung are transplanted into the human body, high doses of hormones must be applied during the perioperative period due to immune rejection, which may induce aseptic femoral head necrosis (FHAVN), which can occur months to years after hormone application or as late as more than 10 years later. In addition, after transplantation, patients must take long-term immunosuppressive drugs to ensure that the transplanted organ and their own immune system are at peace, so their immune function is at a relatively low level, and they are prone to bacterial, viral, mycobacterial, and even fungal infections, and the reserve function and compensatory capacity of multiple organs of multiple systems, such as hematopoiesis, are suppressed. Furthermore, organ transplant patients are often accompanied by corresponding underlying diseases, which in turn adds more risks to the surgery and places higher demands on the entire medical team. As we all know, FHAVN is originally a treatment problem, and the current accepted treatment strategy is to treat young patients with early lesions by head preservation, while patients with advanced necrosis or older patients can only be treated by artificial joint replacement surgery. The two patients recently treated in our department are a 31-year-old young woman with a thin body shape and early necrosis bilaterally, who underwent bilateral simultaneous decompression of the femoral head medullary core and bilateral iliac bone with artificial bone mixed with compression bone grafting. The patient did not complain of any discomfort after the operation, but had “poor appetite” and “poor energy” as usual, but the routine blood test on the third day after the operation showed that the hemoglobin value dropped severely to severe anemia, which improved significantly after blood transfusion. The other case was a 59-year-old male with bilateral necrosis and significant collapse of the left femoral head, so total hip replacement surgery was performed on the left side, and everything went smoothly during the surgery and early postoperative period, but on the 6th postoperative day, he developed a sudden high fever, which was clearly identified as an attack of acute prostatitis after active examination, and gradually improved after appropriate treatment, but the prostatitis condition has since recurred. If the heart survives after heart transplantation, the cardiac function is often normal and the patient’s quality of life is relatively high, but the blow of the surgery will make him or her “unrecognizable” and the risk of the entire perioperative period is much higher than that of the normal population. Therefore, the surgical treatment of FHAVN in these patients must be backed up by the strong comprehensive strength of the relevant departments, in addition to the excellent surgical skills and management abilities of the joint surgeons themselves. Our hospital has decades of experience in heart, liver and kidney transplantation, and has long been famous in the world. Moreover, many related departments such as anesthesiology, surgical care unit and cardiology are the leading ones in China, and the close cooperation with sister departments is the prerequisite for our successful management of these two patients. Combined with our previous experience in joint replacement surgery for patients after liver and kidney transplantation, detailed preoperative evaluation and preparation, minimally invasive and rapid surgical operations, perfect anesthesia and perioperative monitoring, and close cooperation of multidisciplinary teams are the guarantee of success for patients after organ transplantation.