Osteonecrosis of the knee: review

Abstract

Osteonecrosis is a devastating disease that can lead to end-stage arthritis of various joint including the knee. There are three categories of osteonecrosis that affect the knee: spontaneous osteonecrosis of the knee (SONK), secondary, and post-arthroscopic. Regardless of osteonecrosis categories, the treatment of this disease aims to halt further progression or delay the onset of end-stage arthritis of the knee. However, once substantial joint surface collapse has occurred or there are sign of degenerative arthritis, joint arthroplasty is the most appropriate treatment option. Currently, the non-operative treatment options consist of observation, non-steroidal anti-inflammatory drugs (NSAIDs), protected weight bearing, and analgesia as needed. Operative interventions include joint preserving surgery, unilateral knee arthroplasty (UKA), or total knee arthroplasty (TKA) depending on the extent and type of disease. Joint preserving procedures (i.e., arthroscopy, core decompression, osteochondral autograft, and bone grafting) are usually attempted in pre-collapse and some post-collapse lesions, when the articular cartilage is generally intact with only the underlying subchondral bone being affected. Conversely, after severe subchondral collapse has occurred, procedures that attempt to salvage the joint are rarely successful and joint arthroplasty are necessary to relieve pain. The purpose of this article is to highlight the recent evidence concerning the treatment options across the spectrum of management of osteonecrosis of the knee including lesion observation, medications, joint preserving techniques, and total joint arthroplasties.

Keywords: Avascular necrosis; arthroplasty; knee pain; osteonecrosis; postarthroscopic osteonecrosis; spontaneous osteonecrosis of the knee (SONK).

Figure 1

Treatment algorithm for spontaneous osteonecrosis of knee determined by size of the lesion. SONK, spontaneous osteonecrosis of the knee; UKA, unicompartmental knee arthroplasty; TKA, total knee arthroplasty; NSAIDs, non-steroidal anti-inflammatory drugs.

Figure 2

Treatment algorithm for secondary osteonecrosis of the knee determined by asymptomatic or symptomatic lesions. NSAIDs, non-steroidal anti-inflammatory drugs; TKA, total knee arthroplasty.

Figure 3

Treatment algorithm for post-arthroscopic osteonecrosis of the knee. NSAIDs, non-steroidal anti-inflammatory drugs; SONK, spontaneous osteonecrosis of the knee.