Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

Abstract

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

Lateral Unicompartmental knee arthroplasty for a secondary osteonecrosis of the lateral femoral condyle. A case report

“…Joint arthroplasty is the most appropriate surgical option when the severe subchondral collapse occurred. Although total knee arthroplasty (TKA) is suggested in patients with secondary osteonecrosis [3,16], several studies have demonstrated excellent results of UKA treating for advanced-stage osteonecrosis of the knee [17][18][19][20]. Parratte S et al [21] found that there was a 12year Kaplan-Meier survivorship of 96.7% in 30 patients with osteonecrosis at a minimum follow-up of 3 years, including 10 UKAs in patients with secondary osteonecrosis.…”

Treatment options for secondary osteonecrosis of the knee

“…The choice of appropriate arthroplasty is based on local and general conditions. [54][55][56][62][63][64] Uni-compartmental arthroplasty is a successful treatment of SONK. However, unlike spontaneous osteonecrosis, SON can involve epiphysis and diaphysis, and most of the cases have bicondylar involvement.…”

“…54,56 To maximize prosthesis stability, early diagnoses, strict indications, and effective surgical techniques are essential. 55,66 In a literature review, Myers66 found that T.K.A. for SONK was associated with a better outcome than T.K.A.…”

“…present in 57 cases. 55 In cases of extended lesions, the use of a stem is recommended to guarantee good stability; moreover, based on the extension of the lesions and the local and general features of the patient, specific authors suggested considering the use of stem in combination with a wedge or hinged arthroplasty. 63,64 Recently, Boontanapibul reported an implant survival rate of 92%, with a significant improvement of symptoms at the 72-month follow-up in 32 cemented T.K.A.s among patients treated for S.O.N., with a mean age of 43 years; stem extension was used in 8% of cases and constraint implants in 3% of cases.…”

Bladder perforation by orthopedic implants 26 years after limb-sparing surgery for left proximal femoral chondrosarcoma: A case report

“…Many published reports have described the long-term survivorship of implants, including good results in cases of total hip and total knee arthroplasty and anatomical shoulder replacement [ [5] , [6] , [7] ]. However, implant failures such as fractures, loosening, and infection have also been reported [ 8 , 9 ].…”