Rijnen, Wim H. C.; Luttjeboer, Jaap S.; Schreurs, B. Willem; Gardeniers, Jean W. M.
November 2006
Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p62
Academic Journal
Background: Osteonecrosis of the distal portion of the femur produces a segment of dead bone in the weight-bearing portion of the femoral condyle, frequently associated with subchondral fracture and collapse and eventually resulting in secondary osteoarthritis. Treatment of these late stages of osteonecrosis in the knee can be problematic. The purpose of the present study was to evaluate a new surgical technique in which the subchondral osteonecrotic lesion is removed. The bone defect is then reconstructed with impacted bone grafts to prevent collapse and/or to regain distal femoral sphericity. Methods: In this prospective, one-surgeon study, nine consecutive knees in six patients were studied, all of which had extensive corticosteroid-associated osteonecrotic lesions of the femoral condyles. Six knees had collapsed lesions when they were initially treated. The mean age of the patients was thirty-one years. Both the clinical and radiographic outcomes were assessed at a minimal follow-up time of two years. Results: At a mean follow-up time of fifty-one months, none of the reconstructed knees had been converted to a total knee prosthesis. The objective Knee Society score improved from a mean of 63 to 89 points. The functional Knee Society score improved from a mean of 19 to 81 points. During the follow-up period, there was no progression of collapse observed; however, three knees showed early signs of osteoarthritis. Clinical success was achieved in six of eight knees, and radiographic success was achieved in seven of nine knees. Conclusions: At the time of writing (at the time of midterm follow-up), this method appears attractive as a joint-preserving procedure. It is a relatively simple procedure that is not likely to interfere with future knee procedures. It appears that this technique can be effective in knees with collapse of the femoral condyle, and it may delay the need for a total knee arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.


Related Articles

  • POSTERIOR ROTATIONAL OSTEOTOMY FOR NONTRAUMATIC OSTEONECROSIS WITH EXTENSIVE COLLAPSED LESIONS IN YOUNG PATIENTS. Atsumi, Takashi; Kajiwara, Toshihisa; Hiranuma, Yasunari; Tamaoki, Satoshi; Asakura, Yasuhiro // Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p42 

    Background: In young patients with nontraumatic femoral head osteonecrosis with extensive and collapsed lesions, joint preservation is a goal if total joint arthroplasty is to be avoided. We evaluated the effectiveness of a posterior rotational osteotomy in this patient population. Methods: We...

  • SURVIVORSHIP ANALYSIS AND RADIOGRAPHIC OUTCOME FOLLOWING TANTALUM ROD INSERTION FOR OSTEONECROSIS OF THE FEMORAL HEAD. Veillette, Christian J. H.; Mehdian, Hossein; Schemitsch, Emil H.; McKee, Michael D. // Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p48 

    Background: For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas...

  • BIOPHYSICAL STIMULATION WITH PULSED ELECTROMAGNETIC FIELDS IN OSTEONECROSIS OF THE FEMORAL HEAD. Massari, Leo; Fini, Milena; Cadossi, Ruggero; Setti, Stefania; Traina, Gian Carlo // Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p56 

    Background: Osteonecrosis of the femoral head is the end point of a disease process that results in bone necrosis, joint edema, and cartilage damage. It leads to joint arthritis that necessitates total hip arthroplasty in many patients. Because of its positive effects on osteogenesis and its...

  • THE EFFECTIVENESS OF SELF-ADJUSTABLE CUSTOM AND OFF-THE-SHELF BRACING IN THE TREATMENT OF VARUS GONARTHROSIS. Draganich, Louis; Reider, Bruce; Rimington, Todd; Piotrowski, Gary; Mallik, Krishna; Nasson, Scott // Journal of Bone & Joint Surgery, American Volume;Dec2006, Vol. 88-A Issue 12, p2645 

    Background: A recent development in valgus-producing knee braces has been the adjustable "unloader" brace. The purpose of this study was to compare the effectiveness of off-the-shelf and custom-made patient-adjustable, valgus-producing knee unloader braces in relieving pain, reducing stiffness,...

  • Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy. Akamatsu, Y.; Sotozawa, M.; Kobayashi, H.; Kusayama, Y.; Kumagai, K.; Saito, T. // Knee Surgery, Sports Traumatology, Arthroscopy;Nov2016, Vol. 24 Issue 11, p3661 

    Purpose: To assess which tibial slope measurements on knee, whole leg radiographs and three-dimensional reconstructed computed tomography (CT) were useful in clinical practice before and after opening wedge high tibial osteotomy.Methods: Medial and lateral tibial slopes...

  • No correction angle loss with stable plates in open-wedge high tibial osteotomy. Kim, Min; Ha, Jeong; Lee, Dhong; Nam, Sang; Kim, Jin; Lee, Yong // Knee Surgery, Sports Traumatology, Arthroscopy;Jul2015, Vol. 23 Issue 7, p1999 

    Purpose: The aim of this study was to compare the clinical and radiological results of the wedge plate and locking plate systems in open-wedge high tibial osteotomy. Methods: Between 2007 and 2010, the wedge plate was used as the fixation device for osteotomy to treat a total of 67 patients;...

  • Knee function and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: long-term follow-up. Struewer, Johannes; Frangen, Thomas; Ishaque, Bernd; Bliemel, Christopher; Efe, Turgay; Ruchholtz, Steffen; Ziring, Ewgeni // International Orthopaedics;Jan2012, Vol. 36 Issue 1, p171 

    Purpose: The aim of this investigation was to study patient-reported long-term clinical outcome, instrumental stablitity and prevalence of radiological osteoarthritis (OA) a minimum of ten years after isolated anterior cruciate ligament (ACL) reconstruction. Methods: An average of 13.5 years...

  • A Unique Treatment for Talar Osteonecrosis: Placement of an Internal Bone Stimulator. Holmes Jr., George B.; Wydra, Frank; Hellman, Michael; Gross, Christopher E. // Case Connector;Jan-Mar2015, Vol. 5 Issue 1, p1 

    Case: There are many treatment options for talar osteonecrosis without collapse, ranging from restricted weight-bearing to arthrodesis. We present a patient with talar osteonecrosis without evidence of collapse. After conservative treatment had failed, she was treated successfully with...

  • Computer-assisted navigation decreases the change in the tibial posterior slope angle after closed-wedge high tibial osteotomy. Bae, Dae; Ko, Young; Kim, Sang; Baek, Jong; Song, Sang; Bae, Dae Kyung; Ko, Young Wan; Kim, Sang Jun; Baek, Jong Hun; Song, Sang Jun // Knee Surgery, Sports Traumatology, Arthroscopy;Nov2016, Vol. 24 Issue 11, p3433 

    Purpose: The purpose of the present study was to compare the change in tibial posterior slope angle (PSA) between patients treated via computer-assisted and conventional closed-wedge high tibial osteotomy (CWHTO). It was hypothesized that a decrease in the PSA would be less in the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics