Spontaneous Osteonecrosis of the Knee in the Elderly over 60 Years Old

Hong Chul Lim; Kyoung Sun Noh; Jae Hyuk Yang; Ki Mo Jang

doi:10.4055/jkoa.2007.42.5.571

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Lim, Noh, Yang, and Jang: Spontaneous Osteonecrosis of the Knee in the Elderly over 60 Years Old

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(5): 571-577.

Published online: 31 October 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.5.571

Spontaneous Osteonecrosis of the Knee in the Elderly over 60 Years Old

Hong Chul Lim, M.D., Kyoung Sun Noh, M.D., Jae Hyuk Yang, M.D., Ki Mo Jang, M.D.

Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Address reprint requests to Hong-Chul Lim, M.D. Department of Orthopaedic Surgery, Guro Hospital, Korea University, 80, Guro-dong, Guro-gu, Seoul 152-050, Korea. Tel: +82.2-818-6680, Fax: +82.2-865-5774, lhc2455@paran.com

Abstract

Purpose

This study examined the results of treatment according to the stage and size of a spontaneous osteonecrosis lesion of the knee (SONK) in the patients over 60 years of age.

Materials and Methods

Twenty-two knees from 19 patients over 60 years of age were treated for spontaneous osteonecrosis of the knee at our institution between January, 2000, and June, 2004. The mean follow time was 20.7 months. The condylar ratios, proportion of the lesion size to the condyle were measured. The size was obtained by multiplying the values from the anteroposterior and lateral radiographs. The stages were classified radiographically, and the treatment results were analyzed according to the size and stage. Conservative treatment was performed if the ratio and size were <40% and 5.0 cm², respectively. Arthroplasty was performed if the ratio or size was >40% or 5.0 cm². A paired T-test, Spearman correlation test and Wilcoxon test were used for the statistical evaluation.

Results

There was a higher prevalence in females (15 patients, 79%), and the mean age was 65 years (46-77 years). Bilateral involvement was observed in 3 patients. The lesions involved mainly the medial femoral condyle (21 cases, 95%). Seven cases (31%) had a condylar ratio <40% and 15 cases (69%) had a condylar ratio >40%. Conservative treatments were performed in 5 cases staged radiographically as I or II and there were no significant changes in the knee scores (ρ=0.931). Of the 17 cases staged III and IV radiographically, conservative treatment and arthroplasty were performed in 7 and 10 cases, respectively. Seven cases, in whom conservative treatments had been performed, showed a decreased in the knee scores compared with the increased knee scores in 10 patients treated with arthroplasty (ρ=0.943).

Conclusion

An accurate diagnosis and measurement of the size and staging of spontaneous osteonecrosis of knee in patients over 60 years of age is important for proper treatment. Clinically, no further progression of symptoms is visible on grade I and II spontaneous osteonecrosis of the knee after conservative treatment. However, arthroplasty improves the clinical results in patients with radiological grade III and IV osteonecrosis compared with conservative treatment.

Keywords: Knee, Spontaneous osteonecrosis, Arthroplasty

Figures and Tables

Fig. 1

(A) Simple radiography for measuring the size of the lesion on the anterior-posterior view. The condylar ratio and transverse diameter can be measured. (B) Simple radiography for measuring the size of the lesion on the lateral view. The depth can also be measured. ^*a: Maximum transverse width of the medial femoral condyle on the anteriorposterior radiography, b: Transverse width of the lesion on anteriorposterior radiography, c: The greatest length of the lesion on lateral radiography.

Fig. 2

Outcome of conservative treatment in stages I and II. There is a strong correlation in the outcome of conservative treatment (ρ=0.931). ^*AKSS: American Knee Society Score.

Fig. 3

(A) On the initial simple radiography we cannot identify the lesion in the medial condyle of the femur (stage I). (B) After conservative treatment (12 months), the follow-up radiography showed a collapse of the medial femoral condyle (arrow).

Fig. 4

Outcome of conservative and surgical treatment in stages III and IV. There is a statistical difference between the outcomes of conservative treatment and surgical treatment (p<0.005). ^*AKSS: American Knee Society Score

Fig. 5

Outcome of surgical treatment (UKA vs. TKA). There is a strong correlation between the outcomes of UKA and TKA (ρ=0.943). ^*AKSS, American Knee Society Score, UKA: Uni-Knee Arthroplasty, TKA: Total Knee Arthroplasty.

Table 1

Modified Ficat and Alert Classification

Table 2

Number of Cases according to the Condylar Ratio

Table 3

No. of Cases according to the Area of the Lesion

Table 4

No. of Cases according to the Radiological Classification

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