Osteonecrosis of the knee: Diagnosis and outcome in 40 patients

Abstract

Clinically suspected primary osteonecrosis of the knee was studied in 40 patients with repeated plain radiography and scintimetry, and the patients were followed for 1-7 years. Thirty-three patients had typical scintimetric and radiographic signs of osteonecrosis of either one of the femoral condyles, whereas 7 patients had only typical scintimetric findings, but never developed an osteonecrosis based on plain radiography. Because the scintimetric findings were identical to the other 33 knees and because there is no other well-known localized disease in this region of the femoral condyle, we deemed that these 7 patients had probable osteonecrosis, but in an abortive form. The scintimetries were prognostic during the second half year after onset. Thirty knees had a poor outcome--29 because of development of arthrosis, of which eight were treated with a knee arthroplasty and four with a proximal osteotomy.

Treatment of Secondary Osteonecrosis of the Knee With Local Debridement and Osteoprogenitor Cell Grafting

“…The size can be measured by either the ratio [16] or the area [17] technique. Studies have shown that there is no difference between the two methods in predicting prognosis [18,19]. We used the ratio method and classified a lesion as being large if it involved more than 0.32 of the involved condyle width.…”

Defining the role of bisphosphonates for osteonecrosis of the knee: a systematic review

“…Jureus et al 60 reported 40 patients with mean follow-up of 9 yr and showed a 75% incidence of radiographic osteoarthritis and that 42.5% required either arthroplasty or osteotomy. Al-Rowaih et al 18 similarly followed 40 patients from 1-7 yr and reported that 72.5% developed osteoarthritis and 30% required either an arthroplasty or osteotomy. Only one of the case series 52 reported the incidence of osteoarthritis on radiographic follow-up and reported that at between 1-4 yr 59% had evidence of osteoarthritis radiographically, which is comparable to the previous reports referenced given the differing lengths of follow-up.…”

“…Only one of the case series 52 reported the incidence of osteoarthritis on radiographic follow-up and reported that at between 1-4 yr 59% had evidence of osteoarthritis radiographically, which is comparable to the previous reports referenced given the differing lengths of follow-up. 18,60 Two studies commented on the requirement for surgery after bisphosphonate treatment, and this ranged from 7-12%, although the follow-up in these studies ranged from 6 mo to 4 yr, limiting comparison to the referenced papers. 50,52 The type of outcomes recorded varied in type and quality, the use of a validated knee PROM would have been optimal and was only recorded in the randomized controlled trials 51 where it was a secondary outcome measure.…”

“…12 The size of osteonecrotic lesion has been shown to be prognostic, with good to excellent results in small lesions (less than 40% of width of the femoral condyle). 12,18 PAON is a rare complication of arthroscopic surgery and was first reported by Brahme et al 19 The high number of arthroscopic procedures performed and the relatively few reports of PAON imply its incidence is low. 20,21 Typically, the patient presents with persistent or worsening pain and often the presence of an effusion; 20 therefore, the diagnosis must be considered in those who fail to improve after arthroscopic surgery.…”

Laser-Needle Therapy for Spontaneous Osteonecrosis of the Knee

“…But even in such cases, progression can not always be successfully hindered, and patients with severe necrotic changes may require surgical intervention (e.g., high tibial osteotomy or total knee replacement). 2,[8][9][10] In this context and in consideration of the basic research on the biostimulatory effects of low-level laser therapy (LLLT) on microcirculation and vascularization as well as on osteogenesis, and its clinical effectiveness in bone and joint diseases such as osteoarthritis and rheumatoid arthritis, we propose LLLT as a promising therapeutic option for patients with SONK. [11][12][13][14][15][16] However, clinical data on its effectiveness are currently lacking.…”