Atraumatic Osteonecrosis of the Knee*

Mont, Michael A.; Baumgarten, Keith M.; Rifai, Aiman; Bluemke, David A.; Jones, Lynne C.; Hungerford, David S.

doi:10.2106/00004623-200009000-00008

Cited by 205 publications

(175 citation statements)

References 32 publications

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“…The rate of progression of ON to humeral head collapse in the shoulder appeared lower than in the hip in our patients, at least if we accept that ON of the hip and shoulder occurred at the same time in the same patients. As reported with other series of hip or knee ON related to corticosteroids [6,8,11,14], the rate of progression of the disease was more rapid in symptomatic than in asymptomatic shoulders and in shoulders with Stage II ON than in Stage I ON. However, no humeral head collapse was observed before 5 years for small Stage II lesions, whatever the symptoms (Fig.…”

Section: Discussionsupporting

confidence: 78%

“…Our results in the shoulder are consistent with results of others suggesting some early hip [1] or knee lesions [17] may have spontaneous complete or incomplete regression. This situation was rare (6%) in this series of patients with ON related to high doses of corticosteroids and underlying diseases as compared with the prevalence of regression (41%) observed for the knee [11]. The progression of the disease to humeral head collapse was observed in 71 (54%) of the 132 asymptomatic shoulders and in 68 (82%) of the 83 symptomatic shoulders.…”

Section: Discussionmentioning

confidence: 61%

“…In patients taking corticosteroids, ON commonly occurs in the humeral head [2,9], and the femoral head and knee [11]. However, relatively little is known regarding the rate of progression of the disease and the risk factors of progression of ON in symptomatic and asymptomatic shoulders.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Hernigou

Flouzat-Lachaniette

Roussignol

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the rate and factors of progression of shoulder osteonecrosis (ON) related to corticosteroids. Purpose We retrospectively evaluated 125 patients (215 shoulders) with humeral head ON diagnosed by MRI to determine the delay between corticosteroid treatment and the different stages and factors influencing the progression of the disease. Methods Seventy-four of the shoulders had asymptomatic Stage I ON, 58 had asymptomatic Stage II ON, 46 had symptomatic Stage I ON, and 37 had symptomatic Stage II ON. The minimum followup was 10 years (average, 14 years; range, 10-20 years). The delay between the beginning of the corticosteroid treatment and the diagnosis of ON of the humeral head averaged 15 months (range, 6-24 months). Results We observed partial or total regression on MRI only in patients with asymptomatic Stage I ON. At last followup, pain had developed in 98 (74%) and collapse had occurred in 71 (54%) of the 132 previously asymptomatic shoulders. Of the 83 symptomatic shoulders, 68 (82%) had collapsed at the final followup. The time between diagnosis and collapse averaged 10 years for patients with symptomatic Stage I ON and 3 years for patients with symptomatic Stage II ON. Conclusions Stage at initial visit, occurrence of pain, and continuation of peak doses of corticosteroids predicted progression of disease in asymptomatic shoulders, whereas in the symptomatic shoulders, extent and location of the lesion were the main risk factors for progression.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 61%

See 1 more Smart Citation

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Hernigou

Flouzat-Lachaniette

Roussignol

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Section: Introductionmentioning

confidence: 91%

“…More recently, Mont et al [25] reported the limited involvement of the periarticular bone in this disease. Some surgeons believe joint arthroplasty is the only reasonable treatment for late-stage spontaneous osteonecrosis of the knee with secondary joint collapse [1,23,25]. UKA seems to be an appropriate procedure [19,20,33], particularly for patients older than 65 years with unaffected lateral and patellofemoral compartments [19,21,24,35,36].…”

Section: Introductionmentioning

confidence: 91%

Is Unicompartmental Arthroplasty an Acceptable Option for Spontaneous Osteonecrosis of the Knee?

Bruni

Iacono

Raspugli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The literature suggests survivorship of unicompartmental knee arthroplasties (UKAs) for spontaneous osteonecrosis of the knee ranges from 93% to 97% at 10 to 12 years. However, these data arise from small series (23 to 33 patients), jeopardizing meaningful conclusions. Questions/purposes We determined (1) the longer-term survivorship of UKAs in a larger group of patients with spontaneous osteonecrosis of the knee; (2) their subjective, symptomatic, and functional outcomes; and (3) the percentage of failures and reasons for failures to identify relevant indications, contraindications, and technical parameters for treatment with a modern implant design. Methods We retrospectively evaluated all 84 patients with late-stage spontaneous osteonecrosis of the knee who had a medial UKA from 1998 to 2005. All patients had preoperative MRI to confirm the diagnosis, exclude metaphyseal involvement, and confirm the absence of major degenerative changes in the lateral and patellofemoral compartments. The mean age of the patients at surgery was 66 years and mean BMI was 28.9. We conducted KaplanMeier survival analysis using revision for any reason as the end point. Minimum followup was 63 months (mean, 98 months; range, 63-145 months). Results Ten-year survivorship was 89%. Ten revisions were performed; the most common reasons were subsidence of the tibial component (four) and aseptic loosening of the tibial component (three). No patient underwent revision for progression of osteoarthritis in the lateral or patellofemoral compartments. Conclusions Our data suggest spontaneous osteonecrosis of the knee may be an indication for UKA, provided secondary osteonecrosis of the knee is ruled out, preoperative

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Early signs of osteoarthritis in differing rat osteochondral defects

Chihab,

Eng,

Kaiser

et al. 2024

Journal Orthopaedic Research

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Preclinical models of osteochondral defects (OCDs) are fundamental test beds to evaluate treatment modalities before clinical translation. To increase the rigor and reproducibility of translational science for a robust “go or no‐go,” we evaluated disease progression and pain phenotypes within the whole joint for two OCD rat models with same defect size (1.5 x 0.8 mm) placed either in the trochlea or medial condyle of femur. Remarkably, we only found subtle transitory changes to gaits of rats with trochlear defect without any discernible effect to allodynia. At 8‐weeks post‐surgery, anatomical evaluations of joint showed early signs of osteoarthritis with EPIC‐microCT. For the trochlear defect, cartilage attenuation was increased in trochlear, medial, and lateral compartments of the femur. For condylar defect, increased cartilage attenuation was isolated to the medial condyle of the femur. Further, the medial ossicle showed signs of deterioration as indicated with decreased bone mineral density and increased bone surface area to volume ratio. Thus, OCD in a weight‐bearing region of the femur gave rise to more advanced osteoarthritis phenotype within a unilateral joint compartment. Subchondral bone remodeling was evident in both models without any indication of closure of the articular cartilage surface. We conclude that rat OCD, placed in the trochlear or condylar region of the femur, leads to differing severity of osteoarthritis progression. As found herein, repair of the defect with fibrous tissue and subchondral bone is insufficient to alleviate onset of osteoarthritis. Future therapies using rat OCD model should address joint osteoarthritis in addition to repair itself.

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Atraumatic Osteonecrosis of the Knee*

Cited by 205 publications

References 32 publications

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Is Unicompartmental Arthroplasty an Acceptable Option for Spontaneous Osteonecrosis of the Knee?

Early signs of osteoarthritis in differing rat osteochondral defects

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