PROGNOSIS IN SPONTANEOUS OSTEONECROSIS OF THE KNEE: Investigation by Radionuclide Scintimefry and Radiography
01 Nov 1970-Journal of Bone and Joint Surgery-british Volume (Bone and Joint Journal)-Vol. 52, Iss: 4, pp 605-612
TL;DR: In this article, the diagnosis of spontaneous osteonecrosis was based on a subchondral transradiancy in the weightbearing surface of the medial femoral condyle.
Abstract: In fifty-two knees with spontaneous osteonecrosis the diagnosis was based on a subchondral transradiancy in the weight-bearing surface of the medial femoral condyle. Strontium-85 scintimetry showed a unique pattern, indicating a lively repair reaction by localised high values. Thirteen of fifteen knees followed between two and twenty-three years developed osteoarthritis. The prognosis was based on the size of the transradiancy and the focality of the lesion as determined by scintimetry. It is suggested that scintimetry permits differentiation between primary osteoarthritis and arthritis secondary to osteonecrosis.
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TL;DR: The histopathological findings suggest that the primary event leading to spontaneous osteonecrosis of the knee is a subchondral insufficiency fracture and that the localized osteoarthritic changes seen in association with this disease is the result of a fracture.
Abstract: Background:Spontaneous osteonecrosis of the knee is a superficial subchondral lesion classically seen in the medial femoral condyle; in general, it is markedly different in its clinicopathological presentation from the classic wedge-shaped subchondral osteonecrotic lesions seen in the hip, k
317 citations
TL;DR: A prospective study of 105 knees in 91 patients with idiopathic osteonecrosis of the femoral condyles, with an average follow-up of five years in 101 knees, finding the best results were obtained with the total-condylar prosthesis.
Abstract: This is a prospective study of 105 knees in 91 patients with idiopathic osteonecrosis of the femoral condyles, with an average follow-up of five years in 101 knees. Forty-eight of the 75 patients in whom the body weight was studied were obese and four of the 33 patients in whom a densitometry study was done showed decreased bone density. Prognosis is unfavourable if the lesion is larger than five square centimetres and if its width is more than 40 per cent of that of the condyle. Of the 22 patients followed up after conservative treatment 80 per cent were satisfactory. Of the 11 knees treated by arthrotomy alone 55 per cent were satisfactory. Of the 31 knees treated by osteotomy (21 with associated arthrotomy) 87 per cent were satisfactory. Arthrotomy did not significantly improve the results of osteotomies. The ideal correction was to 10 degrees of valgus. Of the 37 knees treated with replacement 95 per cent were satisfactory, and the best results were obtained with the total-condylar prosthesis.
215 citations
TL;DR: Six cases of spontaneous osteonecrosis of the medial femoral condyle were found during a 40-month period and it required two or more months for the characteristic flattening of the condyle and a condylar radiolucency with a surrounding sclerotic border to appear.
Abstract: Six cases of spontaneous osteonecrosis of the medial femoral condyle were found during a 40-month period. While each patient presented with pain in the affected joint, it required two or more months for the characteristic flattening of the condyle and a condylar radiolucency with a surrounding sclerotic border to appear. 87mSr scintigrams showed increased uptake over the lesion. The patients ranged in age from 58 to 73 years. The condition may result in either complete resolution or considerable degenerative disease.
135 citations
TL;DR: Patients in Groups I and II obtained relief of pain with conservative treatment; the lesion stabilizes; surgery should be avoided until late degenerative changes become symptomatic; the joints of Group III patients will all collapse rapidly; surgical treatment prior to the development of fixed deformity is advisable.
Abstract: Osteonecrosis of the medial femoral condyle presents as a sudden onset of pain on the medial side of the knee. This is associated with a positive bone scan and, frequently, a radiolucent lesion in the subchondral zone. In a review of 79 patients with this disease, performed to establish guidelines for treatment, the patients are divided into three groups according to clinical course and size of the lesion. Group I patients have typical clinical presentation and positive bone scans, but lack radiologic evidence of the lesion. Group II patients have small lesions, with an average diameter of 32% of that of the medial femoral condyle. Group III patients have large lesions, all with diameters greater than 50% of the diameter of the condyle. Patients in Groups I and II obtained relief of pain with conservative treatment; the lesion stabilizes; surgery should be avoided until late degenerative changes become symptomatic. The joints of Group III patients will all collapse rapidly; surgical treatment prior to the development of fixed deformity is advisable.
131 citations
TL;DR: Initial management of spontaneous ON of the knee and postarthroscopic ON is typically nonsurgical, with observation for clinical or radiographic progression, and early surgical intervention is recommended.
Abstract: Osteonecrosis (ON) of the knee is a progressive disease that often leads to subchondral collapse and disabling arthritis. Recent studies have identified three distinct pathologic entities, all of which were previously described as knee ON: secondary ON, spontaneous ON of the knee, and postarthroscopic ON. Radiographic and clinical assessment is useful for differentiating these conditions, predicting disease progression, and distinguishing these conditions from other knee pathologies. The etiology, pathology, and pathogenesis of secondary ON of the knee are similar to those found at other sites (eg, hip, shoulder). Spontaneous ON is a disorder of unknown etiology. Postarthroscopic ON has been described as an infrequent but potentially destructive complication. Various treatment modalities (eg, core decompression, bone grafting, high tibial osteotomy, arthroplasty), have been used with varying degrees of success for each type of ON. Secondary ON frequently progresses to end-stage disease, and early surgical intervention is recommended. Initial management of spontaneous ON of the knee and postarthroscopic ON is typically nonsurgical, with observation for clinical or radiographic progression.
106 citations
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Journal Article•
1,331 citations
TL;DR: A radiolucent lesion in the medial femoral condyle was observed in 40 knees in 39 patients over age 60 who had had spontaneous onset of severe knee pain and showed evidence of repair of bone tissue.
Abstract: A radiolucent lesion in the medial femoral condyle was observed in 40 knees in 39 patients over age 60. Most patients had had spontaneous onset of severe knee pain. Twelve knees were radiographically normal within 2 months following onset of pain. Seven knees proceeded to osteoarthritis whereas others became rather asymptomatic. Strontium-85 scintimetry of symptomatic knees showed exceedingly high values. Biopsy showed evidence of repair of bone tissue. The condition was identified as osteonecrosis, the natural history and management of which were discussed. Only 2 patients had a history of systemic adrenocorticosteroid treatment; no other conditions commonly associated with osteonecrosis were identified.
373 citations
TL;DR: Indications for corrective osteotomy in gonarthrosis should, therefore, include not only gross deformity, but also barely perceptible instability, supported by cineroentgenography and radionuclide scintimetry.
Abstract: Tibial osteotomy for correction of angular deformity associated with arthrosis was performed in sixty-three knees in fifty-eight patients reviewed one to three years after operation. Half of the patients were older than sixty-five years with a range of forty through eighty-four years. Before and after operation the femorotibial angle was determined by roentgenographic examination in weight-bearing, standing position, and objective evidence of instability of the knee in the frontal plane was recorded. At operation a wedge of cancellous bone was removed proximal to the tibial tuberosity. The patients walked in a plaster cylinder during the immediate postoperative period and bending exercises were started at six weeks. Before the operation the femorotibial angle was more than 177 degrees in the fifty-three varus knees and less than 164 degrees in the ten valgus knees. After the operation forty of the sixty-three knees had a femorotibial angle of 164 to 177 degrees and twenty-three knees were outside these limits due to undercorrection or overcorrection of the deformity. In the former group all were stable, in the latter, only five. Ten of the eighteen unstable knees were painful in contrast to only three of the forty-five stable knees.
These observations are interpreted to mean that pain in osteo-arthritis of the knee is due to instability, increasing with degree of deformity. Indications for corrective osteotomy in gonarthrosis should, therefore, include not only gross deformity, but also barely perceptible instability. The rationale for this approach is supported by cineroentgenography and radionuclide scintimetry. Advanced age, cardiopathy, or gross obesity did not seem to constitute contraindications.
262 citations
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