Spontaneous osteonecrosis of the knee

  • Agrawal A C Professor & HOD Orthopaedics AIIMS, Raipur, CG, India
  • Sonkar D. Assistant. Prof Orthopaedics, GMC Bhopal, MP, India
  • Bhagwat S.V. Assistant Professor, Raipur Institute of Medical Sciences, CG, India
  • Kalia R.B. Associate Professor
Keywords: DMOAD (Disease modifying osteoarthritic drug), NSAID, asymptomatic osteonecrosis

Abstract

Spontaneous osteonecrosis of the knee is mainly seen in women over 60 years of age. This condition is distinguished from secondary conditions such as corticosteroid-induced osteonecrosis. It was originally described and is most common in the medial femoral condyle but can also occur in the tibial plateaus and on the lateral side of the femur also. The radionuclide bone scan will show focally increased uptake before the radiographs are abnormal. Magnetic resonance imaging can also be diagnostic, but the findings may be normal early in the course of the disease. The etiology remains unknown, but it is speculated that primary vascular ischemia or microfractures in osteoporotic bone are causative. Many patients have a benign course followed by resolution of symptoms. Therefore, conservative management is indicated initially. If progressive collapse accompanied by severe symptoms occurs, high tibial osteotomy, unicompartmental replacement, and total knee replacement are therapeutic alternatives. Recognition of this entity is important to avoid needless surgical intervention.1 The case is being reported to sensitize orthopaedic surgeons to the fact that with a normal knee X-ray if the patient complains of severe pain then he may be having a spontaneous osteonecrosis of the knee which can be diagnosed early by a radionuclide scan or a MRI of the knee joint.

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References

Ecker ML, Lotke PA. Spontaneous Osteonecrosis of the Knee. J Am Acad Orthop Surg. May 1994vol. 2 no. 3 173-178.

Ahlback S, Bauer GCH, Bohne WH: Spontaneous osteonecrosis of the knee. Arthritis Rheum 1968;11:705-733.

Aglietti P, Insall JN, Buzzi R, et al: Idiopathic osteonecrosis of the knee: Aetiology, prognosis and treatment. J Bone Joint Surg Br 1983;65:588-597.

Koshino T, Okamoto R, Takamura K, et al: Arthroscopy in spontaneous osteonecrosis of the knee. Orthop Clin North Am 1979;10:609-618.

Jennie McKee. AAOS Now, October 2011, http:// www. aaos. org/news/aaosnow/oct11/clinical7. asp
Published
2015-06-30
How to Cite
1.
Agrawal A C, Sonkar D., Bhagwat S.V., Kalia R.B. Spontaneous osteonecrosis of the knee. ojmpc [Internet]. 2015Jun.30 [cited 2024Mar.28];21(1):11-4. Available from: https://ojmpc.com/index.php/ojmpc/article/view/6
Section
Case Report