Abstract
Introduction: Osteonecrosis of the distal 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.
Materials and Methods: We developed a new surgical technique; the osteonecrotic lesion was removed and impacted bone grafts were used to regain sphericity and prevent collapse. In this prospective one surgeon study, we included 9 consecutive knees (6 patients) with extensive steroid-associated osteonecrotic lesions of the femoral condyles. A new staging system was developed that includes location and quantification of the osteonecrotic lesion.
Results: Six knees showed a preoperative collapse. The mean age of the patients was 31 years (range, 16–47 years). At a mean follow up of 51 months (range, 29–93 months), no conversion to total knee arthroplasty was performed. The objective Knee Society Score improved from 63 to 89 points. The functional Knee Society Score improved from 19 to 81 points. At follow up, there was no progression of collapse observed and only 3 knees showed slight signs of osteoarthritis. The clinical success rate was 75%, and 78% were radiologically successful.
Discussion: This method is attractive as a salvage procedure, is relatively simple and quick and does not interfere with an eventual future total knee arthroplasty.
Editorial Secretaries: Lynne C. Jones, Ph.D.* and Michael A. Mont, M.D. Address for Correspondence: *Lynne C. Jones, Ph.D., Suite 201 GSH POB, 5601 Loch Raven Blvd., Baltimore, MD 21239, USA. Email: ljones3@jhmi.edu
