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Atraumatic osteonecrosis of the knee
M A Mont1, K M Baumgarten, A Rifai
1Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21239, USA. rhondamont@aol.com
The Journal of Bone and Joint Surgery. American Volume
|September 27, 2000
Summary
Atraumatic osteonecrosis of the knee primarily affects women, often linked to corticosteroid use. Early-stage disease treated with core decompression shows a 79% success rate, while total knee arthroplasty has a 71% success rate.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Radiology
Background:
- Atraumatic osteonecrosis (AON) of the knee affects young adults, presenting unique diagnostic and therapeutic challenges.
- Understanding the clinical, demographic, and radiographic features of AON is crucial for effective management.
- This study investigates AON of the distal femur and proximal tibia in patients under 55 years old.
Purpose of the Study:
- To define the clinical, demographic, and radiographic patterns of atraumatic osteonecrosis of the knee at presentation.
- To evaluate the treatment outcomes for atraumatic osteonecrosis of the distal femur and proximal tibia.
Main Methods:
- Retrospective analysis of 248 knees in 136 patients (age < 55) treated between 1974 and 1998.
- Characterization of demographic and radiographic features.
- Evaluation of outcomes for nonoperative treatment, core decompression, arthroscopic debridement, and total knee arthroplasty.
Main Results:
- The study included 106 female and 30 male patients with a mean age of 36 years.
- 90% of patients had a history of corticosteroid use; 74% had immune system diseases (e.g., lupus).
- Core decompression yielded good/excellent outcomes in 79% of early-stage knees, while total knee arthroplasty was successful in 71%.
Conclusions:
- Atraumatic osteonecrosis of the knee predominantly affects women and is strongly associated with corticosteroid use.
- Magnetic resonance imaging (MRI) is recommended for comprehensive joint evaluation.
- Core decompression is effective for early-stage disease, while nonoperative treatment is best reserved for asymptomatic cases.