Osteonecrosis Of Knee Research Articles

Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19). Patients with COVID-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. COVID-19 has been described as a possible cause of knee osteonecrosis (ON). A systematic review was performed to investigate the hypothetical correlation between COVID-19 and knee ON. Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that COVID-19 is an emerging disease, all levels of evidence studies were included. Finally, two case series and three case reports were included. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and COVID-19, treatment of the lesion and its outcomes. A total of seven cases of post-COVID knee ON have been described. Knee pain arose on average 11 weeks after the diagnosis of COVID-19. All patients had knee MRI showing ON. CCS were used to treat COVID-19-related symptoms in four cases. Conservative treatment was successful in five patients. The correlation between COVID-19 and ON remains unclear. Probably post-COVID-19 ON has a multifactorial origin in which factors related to the patient, consequences of COVID-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of COVID-19 in the etiopathogenesis of knee ON.

KNEE OSTEONECROSIS AFTER SARS-COV 2 VIRUS INFECTION.

Osteonecrosis after COVID-19 infection is a complex pathology with multifactorial origin. Factors such as infection itself with associated coagulopathy, as well as genetic mechanisms, and medications used for its treatment such as corticosteroids, may also be involved. The variability in the presentation makes diagnosis difficult, which, if done soon, can help delay progression and reduce morbidity and the need for surgery.This report presents a case of knee osteonecrosis in a female patient who did not have previous knee pathology on imaging tests. She was diagnosed by magnetic resonance imaging months after hospital admission for SARS-COV 2 pneumonia, which required high-dose corticosteroid treatment.

Surgical Trends for Managing Knee Osteonecrosis: A 2010 to 2020 United States Nationwide Study

BackgroundKnee osteonecrosis (ON) is rare, with an estimated incidence of 0.01-0.17 per 1,000 person years. Our study aimed to do the following: 1) quantify total operative procedures with rates normalized to the United States population; 2) compare arthroplasty versus joint-preserving procedural trends; and 3) determine rates of specific operative techniques/demographics in patients aged <50 versus >50 years. MethodsUsing a nationwide database, 8,269 patients diagnosed with knee ON underwent surgical treatment from 2010 to 2020. Documented surgical procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and core decompression. Primary outcomes included procedural utilization with subanalyses comparing arthroplasty versus joint-preserving procedures, and age-stratified by under/over 50 years. Linear regressions were evaluated for trends in procedural volumes over time. ResultsFrom 2010 to 2014, 0.54% of all knee procedures were to treat ON compared to 0.71% from 2015 to 2020 (P < .001). Overall rates of TKA (85.4%) and UKA (10.3%) far exceeded rates of joint preserving procedures (4.3%). Comparing 2010-2014 with 2015-2019, joint-preserving procedures proportionally increased (0.7 to 5.0%, P < .001). Patients <50 years had significantly more joint-preserving procedures (19.5 versus 2.7%). Overall, TKA was the most common procedure (7,062; 85.40%), following by UKA 853; 10.32%) and core decompression (354; 4.28%). ConclusionTo our knowledge, this is the first study to characterize surgical trends in management of knee ON. Overall surgical volume for knee ON has continued to increase, outpacing population growth. Patients who have knee ON are most commonly managed with arthroplasty procedures, specifically TKA. Younger aged patients (<50 years) are more likely to undergo joint-preserving procedures, namely core decompression.

Rare localization of avascular necrosis during treatment of COVID-19 with glucocorticosteroids

The development of bony avascular necrosis induced by glucocorticoid treatment of COVID-19 is a common adverse effect, with femoral head being the most commonly affected. Timely detection of avascular necrosis is important in the prevention of osteoarthrosis and other complications.&#x0D; We present a clinical case of a 54-year-old patient hospitalized for novel coronavirus infection with complaints of severe pain in both knees 2 weeks after the disease onset. Magnetic resonance imaging revealed pronounced changes in both knees, corresponding to avascular necrosis. The results of conservative therapy, including non-steroidal anti-inflammatory drugs and bisphosphonate bone resorption inhibitors, produced a pronounced positive result. At follow-up examination 3 months later, there was no pain, but the knee joints still had slight restrictions of movement. Magnetic resonance imaging showed a significant decrease in the previously detected changes.&#x0D; The side effects of glucocorticoids (impaired glucose tolerance, increased blood pressure, tachycardia, gastrointestinal erosive ulcers, sleep disorders, etc.) are widely known, but knee osteonecrosis caused by steroid intake rarely comes to the attention of clinicians. This clinical case emphasizes the complex nature of osteonecrosis pathogenesis and demonstrates a wide range of complications in corticosteroid therapy.

A rare case of spontaneous osteonecrosis of knee (SONK) treated with osteochondral autologous transfer system (OATS)

A 34 years old male presented with spontaneous onset of progressive left knee pain since 4 weeks which aggravated on strenuous activities with no history of trauma, steroids or alcohol intake. Local tenderness was elicited over joint line with normal xrays and MRI revealed diffuse subchondral oedema with crescent sign hypointense on T1 and hyperintense on T2 weighted images. Diagnosis of spontaneous osteonecrosis of knee (SONK) was made. He was initially managed conservatively with analgesics and calcium supplements with no improvement. So osteochondral autologous transfer system (OATS) surgery was performed. Patient reported dramatic improvement.

28-Year-Old Man With Joint Pain

28-Year-Old Man With Joint Pain

Treatment options for secondary osteonecrosis of the knee.

Knee osteonecrosis is a debilitating progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only solution is total knee arthroplasty. Three types of knee osteonecrosis have been documented in the literature: spontaneous or primitive, secondary, and post arthroscopy. Spontaneous osteonecrosis is the most common type studied in the literature. Secondary osteonecrosis of the knee is a rare disease and, unlike the spontaneous one, involves patients younger than 50 years. It presents a particular set of pathological, clinical, imaging, and progression features. The management of secondary osteonecrosis is determined by the stage of the disorder, the clinical manifestation, the size and location of the lesions, whether the involvement is unilateral or bilateral, the patient's age, level of activity, general health, and life expectancy. This review aims to present the recent evidence on treatment options for secondary osteonecrosis of the knee, including conservative treatment, joint preserving surgery, and knee replacement.

Satisfactory Outcomes of All-Poly Fixed Bearing Unicompartmental Knee Arthroplasty for Avascular Osteonecrosis Versus Osteoarthritis: A Comparative Study With 10 to 22 Years of Follow-up

BackgroundWhile good mid-term results for treating spontaneous knee osteonecrosis (SPONK) with unicompartmental knee arthroplasty (UKA) have been reported, concerns remain about implant survival at long-term. This study aimed to compare outcomes and survivorship of UKA for SPONK vs osteoarthritis at a minimum of 10 years. MethodsThis case-control study included medial UKA for femoral SPONK operated between 1996 and 2010 with a minimum 10-year follow-up (n = 47). Each case was matched with a medial UKA for osteoarthritis based on body mass index (BMI), gender, and age. Knee Society Score (KSS), complications and radiological (loosening) data were collected at the last follow-up. Kaplan-Meier survivorship analysis was performed using revision implant removal as endpoint. ResultsThe mean follow-up was 13.2 years (range 10 to 21 years). Mean age and BMI were 72.9 ± 8.4 years and 25.5 ± 3.6 Kg/m2 in SPONK group. At last follow-up, knee and function KSS were 89.5 ± 12 and 79 ± 18 in SPONK group vs 90 ± 15 (P = .85) and 81.7 ± 17 (P = .47) in control group. Complications and radiological results showed no significant differences. The survival rate free from any revision was 85.1% at last follow-up in SPONK group and 93.6% in control group (P = .23). The leading cause for revision was aseptic tibial loosening (57.1%) in SPONK group. The 15-year survival estimate was 83% in SPONK group. ConclusionSatisfactory clinical outcomes at long-term after UKA for femoral SPONK were observed, similar to those after UKA for osteoarthritis, despite a higher risk of tibial loosening in the SPONK group. No symptomatic femoral loosening leading to a revision was observed. Level of EvidenceIV.

Multifocal, metaphyseal osteonecrosis of knee due to pulse steroid treatment after cessation of fingolimod treatment in a 19-week-pregnant patient

Multifocal, metaphyseal osteonecrosis of knee due to pulse steroid treatment after cessation of fingolimod treatment in a 19-week-pregnant patient

Autologous Osteochondral Transplantation for Young Patients with Postcollapse Osteonecrosis of the Knee: A Retrospective Cohort Study with an Average 7-Year Follow-Up.

Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee. This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software. Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) (P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) (P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period. Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.

A case of bilateral hip and knee osteonecrosis in a patient with ankylosing spondylitis who used steroids due to immune thrombocytopenic purpura

We aim to present a case of bilateral hip and knee osteonecrosis due to steroid use in an ankylosing spondylitis (AS) patient who developed immune thrombocytopenic purpura (ITP) after the use of nonsteroidal anti-inflammatory drugs (NSAID). A 60-year-old male patient was diagnosed with AS with bilateral sacroiliitis and inflammatory low back pain on sacroiliac radiography 10 years ago. He was followed up with NSAIDs. Intravenous steroid treatment was started in the hematology clinic to the patient who had developed ITP due to NSAID usage. The patient presented to our clinic with bilateral hip pain that developed after steroid therapy. He had limited hip joint movement and bilateral destructive hip joints in pelvic radiography. Bilateral total hip arthroplasty (THA) was performed by the Orthopedics and Traumatology Department at 1-year intervals because of osteonecrosis associated with steroid use. When he presented to our clinic 3 years later with bilateral knee pain, we detected osteonecrosis in the distal segments of bilateral femurs and proximal tibial diaphysis on knee MRI. We implemented a rehabilitation program with the conservative treatment recommendation of orthopedics. Comorbidities or drug side effects should be examined more carefully while treating peripheral joint involvement in patients with AS.

Knee osteonecrosis incidence from two real-world data sources

BackgroundAnti-nerve growth factor (NGF) has shown promise for osteoarthritis (OA) pain efficacy, but an unanticipated joint safety signal occurred in trials. To what extent this was related to OA natural history, or was a consequence of anti-NGF agents is unclear. Of the adverse joint safety events identified, osteonecrosis has specific diagnostic codes available in the medical record to enable assessment of its frequency in the general community. We therefore investigated the rates of knee osteonecrosis in three real-world cohorts using two data sources to place these trial data in context. MethodsWe used data from UK-based IQVIA Medical Research Data (IMRD) of adults diagnosed with incident knee OA between 2000 and 2018 to examine the incidence of knee osteonecrosis using different definitions. Additionally, we evaluated the incidence of knee osteonecrosis in the year prior to knee replacement in IMRD and among US Medicare beneficiaries who received a knee replacement in 2011–2014. ResultsIn IMRD, among 122,343 subjects with incident knee OA (mean age 68 years, 58% female), incidence estimates for knee osteonecrosis were 0.006–0.10%, with incidence rates of 0.01–0.17 per 1000 person-years. Among the 81,807 who had a knee replacement, the incidence of knee osteonecrosis in the year prior to knee replacement was 0.004–0.06%. In Medicare, among 316,593 with knee replacement (mean age 74, 68% female), the incidence of knee osteonecrosis was 0.24–0.7%. ConclusionKnee osteonecrosis is rare among people with knee OA, including in the year prior to knee replacement. These data provide context for interpreting osteonecrosis events in NGF trials.

Avascular Necrosis of Bone in Patients with Uveitis Treated with Systemic Corticosteroids

ABSTRACT Purpose: To identify the prevalence, risk factors and outcomes of avascular necrosis (AVN) in patients with chronic uveitis. Methods: A retrospective study of patients with corticosteroid-induced AVN treated at Manchester Uveitis Clinic between 1991 and 2019. Results: From a cohort of 4478 patients, 1698 had been treated with systemic corticosteroids. Five patients with AVN were identified (prevalence 0.29%). The mean age at diagnosis of AVN was 49 years. All 5 patients were using systemic immunosuppression. Four patients developed femoral head AVN in 7 joints, one had bilateral knee osteonecrosis. The mean duration of corticosteroid before AVN was 38 months; the mean dose at onset was 17mg/day and the mean cumulative dose was 18,860mg. Three patients required total hip replacements but management was conservative for others. There was no permanent disability. Conclusions: AVN is a rare but severe complication of corticosteroid therapy. Clinicians should be vigilant for symptoms of bone pain as early detection and cessation of corticosteroids can reverse incipient AVN and avoid surgery.

Osteonecrosis of the Femoral Medial Condyle Due to Leg Length Discrepancy After A Traffic Accident

Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.

Post-arthroscopic osteonecrosis of the knee: A case report and literature review.

Post-arthroscopic osteonecrosis is a rare complication of arthroscopic surgery. The present study reported on a case of knee osteonecrosis after arthroscopic surgery. The patient, an 81-year-old male, presented with left knee pain and limited range of motion without any history of trauma. MRI revealed medial meniscus tear. Medial partial meniscectomy was performed using arthroscopy. The pain was found to be relieved due to the operation. However, there was an aggravation of pain after two months post-operatively. X-ray revealed that the subchondral bone in the medial femoral condyle (MFC) had collapsed. MRI revealed a large area of bone marrow edema in the MFC with cartilage delamination and subchondral flattening. Considering the age of the patient and the large area of bone necrosis, total knee arthroplasty was performed. At the 1-year follow-up, the Knee Society Knee Score improved from 44 points pre-operatively to 90 points and the Knee Society Functional Score was elevated from 35 to 90 points. Patient-reported outcome measures were assessed in the form of the Oxford Knee Score, which was 16. Furthermore, previous case reports of post-arthroscopic osteonecrosis were reviewed and the clinical and radiographic features, as well as the treatment, were summarized. If the patient complains of persistent and worsening pain after arthroscopy, particularly in elderly osteoporotic patients with meniscal tears or chondral lesions, the possibility of post-arthroscopic knee osteonecrosis should be considered. Diagnosis and treatment at the early stages are likely to be beneficial for the outcome.

Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature.

Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as "beginning" or "possible" avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. The study comprised 49 patients aged 22-71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1-5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1-85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.

Medulloscopy-Assisted Surgery for Osteonecrosis of the Knee Following Treatment for Adolescent Leukemia: Mid-term Results.

This study aimed to introduce the medulloscopy-assisted autologous bone graft for osteonecrosis of the knee following adolescent leukemia treatment and to report the mid-term clinical and radiological results. We retrospectively reviewed records of eight consecutive knees in six patients with extensive osteonecrosis of the distal femoral condyles, from 2013 to 2015. All patients were treated with autologous bone grafts using medulloscopy. We evaluated functional and objective Knee Society Score (KSS) pre- and postoperatively. Clinical and radiological outcomes were evaluated at the last follow-up. The mean age of the patients at the time of surgery was 21.5years. The mean follow-up period was 45months. No additional surgery was required during the follow-up period. The mean objective KSS significantly increased from 60.6 points (range 55-65) to 90.0 points (range 70-95), postoperatively (p < 0.001). The mean functional KSS significantly improved from 48.8 points (range 45-55) to 90.0 points (range 80-100) postoperatively (p < 0.001). No patients had progression of collapse of the femoral condyles at the final follow-up. At the final follow-up, the onset of minimal osteoarthritis was seen in two knees, with a Kellgren-Lawrence grade 1. Medulloscopy-assisted bone grafting can be an effective treatment option for early symptomatic osteonecrosis of knee following treatment for adolescent leukemia.

III–3 Low-Intensity Pulsed Ultrasound (LIPUS) for the Treatment of Massive Osteonecrosis Following Carbon Ion Radiotherapy for Malignant Bone Tumor

Objective: Carbon ion radiotherapy (CIR) can be applied for unresectable malignant bone tumors, especially arising from the pelvis and spine. The most serious adverse effect of CIR is a massive osteonecrosis of healthy bone surrounding the tumor. We applied LIPUS therapy in 2 cases and report here their clinical courses. Materials and Methods: Two cases with the pelvic sarcoma were treated by CIR. Thirteen year-old-male had a metastasis of osteosarcoma at the acetabulum. Seventy three year-old-male had a chondrosarcoma in the pubis, acetabulum and iliac bone. Results: Malignant tumors were controlled by CIR only and at present, we find no evidence of disease. Both cases complained of severe hip pain after CIR due to osteonecrosis of the acetabulum. Their pains were well improved at 1 month after LIPUS therapy. Destruction of the hip joint was not observed at the final follow-up. Discussion: Until now, positive effect of LIPUS have been reported on osteonecrosis of knee, hip joint and jaw bone. However, there have been, to our knowledge, no report on applying LIPUS for these difficult conditions. LIPUS therapy seems beneficial for pain relief and bone regeneration for massive osteonecrosis after CIR.

Corticosteroid-induced Knee Osteonecrosis and Accompanying Femoral Head Osteonecrosis

Corticosteroid-induced Knee Osteonecrosis and Accompanying Femoral Head Osteonecrosis

Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up.

Newer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016. A total of 523 patients were identified. Of this cohort, 496 patients had a minimum of 2-year follow-up and were included in our final analysis. Among these patients, 72 had bilateral TKA yielding a total of 568 TKAs. There were 133 men and 363 women who had a mean body mass index of 33 kg/m2 (range, 20-61 kg/m2). The mean age was 66 years (range, 33-88 years). Average follow-up was 36 months (range, 24-48 months). Indications for TKA included osteoarthritis in 432 patients (87%), rheumatoid arthritis in 40 patients (8%), and knee osteonecrosis in 24 (5%) patients. Implant survivorship was defined as any revision leading to explantation of the base plate for any reason. Kaplan-Meier analysis was performed to determine all-cause implant survivorship at final follow-up for every patient. Complications were assessed using the Knee Society standardized list of TKA complications. Clinical outcomes were determined using the Knee Society pain and function scores. Range-of-motion values were also collected. There were a total of four failures, all were due to aseptic loosening with a survivorship rate of 99% at mean follow-up of 3 years (95% confidence interval = 0.984-0.999). In addition, there were a total of 12 surgical and 10 medical complications. Surgical complications did not affect the base plate or result in any additional implant revisions. A total of nine patients had thromboembolic disease complications; all received medical treatment and recovered adequately. Radiological evaluation did not show any signs of loosening or failures in other patients at final follow-up. Knee Society Scores for pain and function improved from 55 and 56 points preoperatively to 92 and 84 points at 2 years postoperatively. Our results are in concordance with the excellent clinical outcomes and survivorship demonstrated for the newer generation cementless TKA implants. In our experience, 3D printed titanium base plates demonstrated clinical success and excellent survivorship at minimum follow-up of 2 years.