Cartilage repair for steroid-induced osteonecrosis of the knee joint

Abstract

Purpose:Surgical treatment for steroid-induced osteonecrosis is challenging one. Purpose of this study was to evaluate the outcome of osteochondral autogenous transfer (OAT) to steroid-induced osteonecrosis of the knee joint. Methods: Thirteen knees (10 patients) of streroid-induced osteonecrosis of femoral condyles were consecutively treated with OAT between year of 2004 and 2011. Average age at the surgery was 31.6 years old. The primary disease was SLE in 6 patients, chronic active EB virus infection in 1 patient, chronic glomeralonephtitis in 1 patient, MCTD in 1patient, and intestinal Bechet's disease in 1 patient. The mean highest corticosteroid dosage per day was 523 mg/day (range;, 30 to 1000mg/day). The average follow up period was 41 month (range;, 4 to 75 months). JOA scoring system was used to evaluate clinical result. Results: The average JOA score improved from 67.5 points preoperatively (range;, 45 to 80) to 91.4 points (range;, 85 to 100) postoperatively. Almost all patients could do Japanese style sitting post operatively. We replaced damaged cartilage together with necrotized bone on the weight-bearing area with osteochondral autograft as much as possible. We also removed as much necrotized bone as possible, and grafted iliac bone if the area of necrotized bone was larger than that where osteochondral plugs could cover. Iliac bone grafting was necessary in 2 knees. Osteotomy was not performed. Necrosis of the femoral neck was seen in 6 patients. There was no major complication such as infection. Conclusions: The present study shows that OAT to steroid-induced osteonecrosis of the knee joint was one surgical option resulting in good short-term outcome.