Avascular Necrosis

Intraosseous Tibial Resuscitation After a Total Knee Arthroplasty Leading to Osteonecrosis and Loosening of the Tibial Component

“…Although the etiology of ON is not fully understood, 1 mechanism involves impaired blood supply due to traumatic disruption or intravascular/extravascular occlusion, leading to cell death [ 14 ]. Implicated as an extravascular cause many years ago, increased IO pressures have been measured in ON [ [14] , [15] , [16] , [17] , [18] ]. For the diagnosis of ON, MRI is the most used modality.…”

“…The prevalence of ON has been shown in a recent study to be 0.17% in patients older than 50 years [ 12 ], and the annual incidence worldwide is estimated to be 1.4-3.0 per 100,000 [ 13 ]. ON of the knee is commonly defined under 3 categories as spontaneous ON of the knee, secondary ON, and postarthroscopic ON [ 14 ]. Causes of ON are classified as traumatic or nontraumatic, with recent studies showing that a nontraumatic cause is almost always associated with metabolic causes such as medical conditions or medications [ 14 ].…”

“…ON of the knee is commonly defined under 3 categories as spontaneous ON of the knee, secondary ON, and postarthroscopic ON [ 14 ]. Causes of ON are classified as traumatic or nontraumatic, with recent studies showing that a nontraumatic cause is almost always associated with metabolic causes such as medical conditions or medications [ 14 ]. We present a case of a patient who developed a traumatic bulla at her IO insertion site and subsequent ON below a total knee arthroplasty (TKA) leading to loosening and necessitating a revision surgery.…”