Treatment options for secondary osteonecrosis of the knee

Abstract

Knee osteonecrosis is a debilitating progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only solution is total knee arthroplasty. Three types of knee osteonecrosis have been documented in the literature: spontaneous or primitive, secondary, and post arthroscopy. Spontaneous osteonecrosis is the most common type studied in the literature. Secondary osteonecrosis of the knee is a rare disease and, unlike the spontaneous one, involves patients younger than 50 years. It presents a particular set of pathological, clinical, imaging, and progression features. The management of secondary osteonecrosis is determined by the stage of the disorder, the clinical manifestation, the size and location of the lesions, whether the involvement is unilateral or bilateral, the patient's age, level of activity, general health, and life expectancy. This review aims to present the recent evidence on treatment options for secondary osteonecrosis of the knee, including conservative treatment, joint preserving surgery, and knee replacement.

Keywords: arthroplasty; joint preservation surgery; knee; mesenchymal stem cells; secondary osteonecrosis.

Figure 1. Secondary osteonecrosis of femoral lateral condyle treated arthroscopically by debridement, bone marrow stimulation and implant of scaffold. (A) X-ray plain. (B) MRI image showing epiphysis involvement. (C) Arthroscopic view of lesion. (D) Post-treatment arthroscopic view.

Figure 2. SON evolved into end-stage osteoarthritis. (A) X-ray plain. (B and C) MRI image showing knee osteoarthritis and involvement of epiphysis and metaphysis. (D) Patient treated with TKA.