Joint-preserving surgical treatment of spontaneous osteonecrosis of the knee.
BACKGROUND
To date, reports of surgical treatment of spontaneous osteonecrosis of the knee (SPONK) refractory to non-operative treatment have primarily focused on knee arthroplasty. This report presents an overview of the characteristics of SPONK and reports our experience with joint-preserving surgical treatment of this condition.


METHODS
Fifteen patients who had joint-preserving surgery after failed non-operative modalities were studied. These patients were treated at a single center between January 1998 and September 2006 with a combination of arthroscopy and core decompression, or osteochondral autograft transfers.


RESULTS
Thirteen of the 15 knees (87%) had knee joint survival with a mean Knee Society Score of 81 points (range 45–100 points) at a mean follow-up of 40 months (range 9–120 months). Five of seven knees treated with core decompression had a successful clinical outcome. One of the patients who failed core decompression later underwent osteochondral autograft transfer, and eight of nine knees treated with this modality had a successful outcome.


CONCLUSIONS
Overall, these results demonstrate that joint-preserving surgical treatment can successfully postpone the need for knee arthroplasty in selected patients with pre-collapse SPONK.
Duany
Nyagon G
NG
Department of Orthopaedic Surgery, Howard University Hospital, 2041 Georgia Avenue, Northwest, Washington, DC 20060, USA.
Zywiel
Michael G
MG
McGrath
Mike S
MS
Siddiqui
Junaed A
JA
Jones
Lynne C
LC
Bonutti
Peter M
PM
Mont
Michael A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001182:Arthroscopy / Q000379:methods*; D002356:Cartilage / Q000637:transplantation; D019902:Chondrocytes / Q000637:transplantation; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome