Analysis of medial unicompartmental knee arthroplasty for patients with spontaneous osteonecrosis of the knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Deqing , HUANG Zida ,  ZHANG Wenming , LIN Jianhua , LI Wenbo

Department of Orthopaedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350005, P.R.China;

Corresponding author：

ZHANG Wenming, Email: zhangwm0591@163.com

Keywords：

Spontaneous osteonecrosis of the knee; anteromedial osteoarthritis; unicompartmental knee arthroplasty

DOI：

10.7507/1002-1892.201805127

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Objective To analyse the effectiveness of unicompartmental knee arthroplasty (UKA) for the patients with spontaneous osteonecrosis of the knee (SONK). Methods Between January 2012 and December 2016, 31 patients with SONK was admitted and treated with medial UKA. All patients were examined by both plain radiography and magnetic resonance images. The patients were composed of 5 men and 26 women with an average age of 64.3 years (range, 48-79 years), and with 16 left joints and 15 right joints. The average disease duration was 14.7 months (range, 6-26 months). Preoperative visual analogue scale (VAS) was 6.00±1.15, Hospital for Special Surgery (HSS) score was 55.77±11.03, and knee range of motion (ROM) was (114.68±10.40)°. The imaging examinations showed that all the lesions were located in the medial compartment of the knee joint and there were 19 patients with Aglietti stage Ⅳ and 12 patients with Aglietti stage Ⅴ. Preoperative femorotibial angle (FTA) was (177.39±1.63)° and posterior tibial slope (PTS) was (84.05±1.39)°. Results All the incisions healed by first intention. All patients were followed up 14-46 months (mean, 25 months). At last follow-up, VAS score was 2.06±0.72 and HSS score was 86.45±3.67, which both improved significantly when compared with preoperative scores (t=22.73, P=0.00; t=–14.72, P=0.00). ROM was (118.06±3.80)° with no significant difference when compared with preoperative ROM (t=–1.78, P=0.08). The X-ray films showed there was no severe adverse events, such as periprosthetic infection, aseptic loosening, bearing dislocation, and so on. At last follow- up, PTS was (85.30±1.19)° with significant difference compared with preoperative one (t=–4.07, P=0.00); while FTA was (177.51±1.98)° with no significant difference when compared with preoperative FTA (t=–0.38, P=0.71). Conclusion UKA may be an optional management for SONK with minimally invasive, bone-preserving, and rapid recovery.

Citation： HU Deqing, HUANG Zida, ZHANG Wenming, LIN Jianhua, LI Wenbo. Analysis of medial unicompartmental knee arthroplasty for patients with spontaneous osteonecrosis of the knee. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 13-17. doi: 10.7507/1002-1892.201805127 Copy

1.	Marcacci M, Andriolo L, Kon E, et al. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Rev, 2017, 1(5): 219-224.
2.	Karim AR, Cherian JJ, Jauregui JJ, et al. Osteonecrosis of the knee: review. Ann Transl Med, 2015, 3(6): 1-11.
3.	Akamatsu Y, Mitsugi N, Hayashi T, et al. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop, 2012, 83(3): 249-255.
4.	Jordan RW, Aparajit P, Docker C, et al. The importance of early diagnosis in spontaneous osteonecrosis of the knee-A case series with six-year follow-up. Knee, 2016, 23(4): 702-707.
5.	Plett SK, Hackney LA, Heilmeier U, et al. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skeletal Radiol, 2015, 44(12): 1785-1794.
6.	Juréus J, Lindstrand A, Geijer M, et al. The natural course of spontaneous osteonecrosis of the knee (SPONK): a 1- to 27-year follow-up of 40 patients. Acta Orthop, 2013, 84(4): 410-414.
7.	Wilmot AS, Ruutiainen AT, Bakhru PT, et al. Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol, 2016, 85(11): 2096-2103.
8.	Ohdera T, Miyagi S, Tokunaga M, et al. Spontaneous osteonecrosis of the lateral femoral condyle of the knee: a report of 11 cases. Arch Orthop Trauma Surg, 2008, 128(8): 825-831.
9.	Yang WM, Zhao CQ, Lu ZY, et al. Clinical characteristics and treatment of spontaneous osteonecrosis of medial tibial plateau: A retrospective case study. Chin Med J (Engl), 2018, 131(21): 2544-2550.
10.	Gorbachova T, Melenevsky Y, Cohen M, et al. Osteochondral lesions of the knee: Differentiating the most common entities at MRI. Radiographics, 2018, 38(5): 1478-1495.
11.	Nakayama H, Iseki T, Kanto R, et al. Analysis of risk factors for poor prognosis in conservatively managed early-stage spontaneous osteonecrosis of the knee. Knee, 2016, 23(1): 25-28.
12.	Hatanaka H, Yamamoto T, Motomura G, et al. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report. Skeletal Radiol, 2016, 45(5): 713-716.
13.	Mears SC, McCarthy EF, Jones LC, et al. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J, 2009, 29: 38-42.
14.	Aglietti P, Insall JN, Buzzi R, et al. Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg (Br), 1983, 65(5): 588-597.
15.	Di Caprio F, Meringolo R, Navarra MA, et al. Postarthroscopy osteonecrosis of the knee: Current concepts. Joints, 2017, 5(4): 229-236.
16.	Mont MA, Baumgarten KM, Rifai A, et al. Atraumatic osteonecrosis of the knee. J Bone Joint Surg (Am), 2000, 82(9): 1279-1290.
17.	Jacobs CA, Berend KR, Lombardi AV Jr, et al. The location and severity of preoperative subchondral bone marrow lesions were not associated with inferior postoperative outcomes after medial unicompartmental knee arthroplasty or total knee arthroplasty. J Arthroplasty, 2016, 31(11): 2476-2480.
18.	Berend KR, Lombardi AV Jr, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplast, 2017, 32(10): 3000-3003.
19.	Ma T, Tu Y, Xue H, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis. J Orthop Surg (Hong Kong), 2017, 25(1): 1-5.
20.	Kaneko T, Kono N, Sunakawa T, et al. Reliable patient-reported outcome measure and survivorship of UKA for primary spontaneous osteonecrosis. Eur J Orthop Surg Traumatol, 2018. [Epub ahead of print].
21.	Chalmers BP, Mehrotra KG, Sierra RJ, et al. Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis. Bone Joint J, 2018, 100-B(4): 450-454.
22.	Jauregui JJ, Blum CL, Sardesai N, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee: A meta-analysis. J Orthop Surg (Hong Kong), 2018, 26(2): 1-6.
23.	郭万首, 张启栋, 刘朝晖, 等. 膝关节单髁置换术治疗晚期膝关节自发性骨坏死. 中华骨科杂志, 2014, 34(6): 631-637.
24.	Guo WS, Zhang QD, Liu ZH, et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee. Orthop Surg, 2015, 7(2): 119-124.

1. Marcacci M, Andriolo L, Kon E, et al. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Rev, 2017, 1(5): 219-224.
2. Karim AR, Cherian JJ, Jauregui JJ, et al. Osteonecrosis of the knee: review. Ann Transl Med, 2015, 3(6): 1-11.
3. Akamatsu Y, Mitsugi N, Hayashi T, et al. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop, 2012, 83(3): 249-255.
4. Jordan RW, Aparajit P, Docker C, et al. The importance of early diagnosis in spontaneous osteonecrosis of the knee-A case series with six-year follow-up. Knee, 2016, 23(4): 702-707.
5. Plett SK, Hackney LA, Heilmeier U, et al. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skeletal Radiol, 2015, 44(12): 1785-1794.
6. Juréus J, Lindstrand A, Geijer M, et al. The natural course of spontaneous osteonecrosis of the knee (SPONK): a 1- to 27-year follow-up of 40 patients. Acta Orthop, 2013, 84(4): 410-414.
7. Wilmot AS, Ruutiainen AT, Bakhru PT, et al. Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol, 2016, 85(11): 2096-2103.
8. Ohdera T, Miyagi S, Tokunaga M, et al. Spontaneous osteonecrosis of the lateral femoral condyle of the knee: a report of 11 cases. Arch Orthop Trauma Surg, 2008, 128(8): 825-831.
9. Yang WM, Zhao CQ, Lu ZY, et al. Clinical characteristics and treatment of spontaneous osteonecrosis of medial tibial plateau: A retrospective case study. Chin Med J (Engl), 2018, 131(21): 2544-2550.
10. Gorbachova T, Melenevsky Y, Cohen M, et al. Osteochondral lesions of the knee: Differentiating the most common entities at MRI. Radiographics, 2018, 38(5): 1478-1495.
11. Nakayama H, Iseki T, Kanto R, et al. Analysis of risk factors for poor prognosis in conservatively managed early-stage spontaneous osteonecrosis of the knee. Knee, 2016, 23(1): 25-28.
12. Hatanaka H, Yamamoto T, Motomura G, et al. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report. Skeletal Radiol, 2016, 45(5): 713-716.
13. Mears SC, McCarthy EF, Jones LC, et al. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J, 2009, 29: 38-42.
14. Aglietti P, Insall JN, Buzzi R, et al. Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg (Br), 1983, 65(5): 588-597.
15. Di Caprio F, Meringolo R, Navarra MA, et al. Postarthroscopy osteonecrosis of the knee: Current concepts. Joints, 2017, 5(4): 229-236.
16. Mont MA, Baumgarten KM, Rifai A, et al. Atraumatic osteonecrosis of the knee. J Bone Joint Surg (Am), 2000, 82(9): 1279-1290.
17. Jacobs CA, Berend KR, Lombardi AV Jr, et al. The location and severity of preoperative subchondral bone marrow lesions were not associated with inferior postoperative outcomes after medial unicompartmental knee arthroplasty or total knee arthroplasty. J Arthroplasty, 2016, 31(11): 2476-2480.
18. Berend KR, Lombardi AV Jr, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplast, 2017, 32(10): 3000-3003.
19. Ma T, Tu Y, Xue H, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis. J Orthop Surg (Hong Kong), 2017, 25(1): 1-5.
20. Kaneko T, Kono N, Sunakawa T, et al. Reliable patient-reported outcome measure and survivorship of UKA for primary spontaneous osteonecrosis. Eur J Orthop Surg Traumatol, 2018. [Epub ahead of print].
21. Chalmers BP, Mehrotra KG, Sierra RJ, et al. Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis. Bone Joint J, 2018, 100-B(4): 450-454.
22. Jauregui JJ, Blum CL, Sardesai N, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee: A meta-analysis. J Orthop Surg (Hong Kong), 2018, 26(2): 1-6.
23. 郭万首, 张启栋, 刘朝晖, 等. 膝关节单髁置换术治疗晚期膝关节自发性骨坏死. 中华骨科杂志, 2014, 34(6): 631-637.
24. Guo WS, Zhang QD, Liu ZH, et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee. Orthop Surg, 2015, 7(2): 119-124.

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Analysis of medial unicompartmental knee arthroplasty for patients with spontaneous osteonecrosis of the knee

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