Literature DB >> 26314796

Analysis of risk factors for poor prognosis in conservatively managed early-stage spontaneous osteonecrosis of the knee.

Hiroshi Nakayama1, Tomoya Iseki2, Ryo Kanto2, Takashi Daimon3, Kaori Kashiwa2, Shinichi Yoshiya2.   

Abstract

BACKGROUND: Management guidelines for early-stage spontaneous osteonecrosis of the knee (SONK) have not been established. The purposes of this study were to review the outcome of conservative treatment for patients with early-stage SONK and to examine clinical factors affecting the prognosis.
METHODS: Diagnosis of early-stage SONK was made based on the criteria consisting of specific clinical features including magnetic resonance imaging (MRI) findings. During the study period, all patients with this diagnosis underwent standardized conservative treatment. The study population comprised 38 knees in 36 patients with a mean age at presentation of 66.4years. The mean follow-up period was 34.9months. During the treatment course, progressive joint space narrowing or collapse of bony contours identified in serial follow-up radiographs was regarded as indicating a poor prognosis. The significance of potential prognostic factors such as age, gender, obesity, coronal alignment, lesion size, and MRI findings was analyzed using a multivariate logistic regression analysis.
RESULTS: The prognosis was defined to be poor in eight knees (21.1%). The multivariate logistic regression analysis for potential risk factors revealed that only varus alignment with a femorotibial angle (FTA) of 180° or more on the initial radiograph was significantly associated with the poor prognosis (P=0.01, odds ratio 28.1) while no other factors significantly correlated with the prognosis.
CONCLUSIONS: Approximately 80% of patients with early-stage SONK could be managed successfully with conservative treatment without progression of the disease process. The presence of varus deformity (FTA of 180° or more) was significantly associated with poor prognosis complicated with progressive deformity and prolonged disability. LEVEL OF EVIDENCE: Level IV, case series.
Copyright © 2015. Published by Elsevier B.V.

Entities:  

Keywords:  Conservative treatment; Knee; Risk factor; Spontaneous osteonecrosis

Mesh:

Substances:

Year:  2015        PMID: 26314796     DOI: 10.1016/j.knee.2015.07.012

Source DB:  PubMed          Journal:  Knee        ISSN: 0968-0160            Impact factor:   2.199


  6 in total

1.  Characteristics, management, and outcomes of spontaneous osteonecrosis of the knee in Indian population.

Authors:  Nishit Bhatnagar; Siddharth Sharma; Virender Kumar Gautam; Ajeet Kumar; Anurag Tiwari
Journal:  Int Orthop       Date:  2018-03-18       Impact factor: 3.075

2.  Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus-Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant.

Authors:  Kohei Nishitani; Yasuaki Nakagawa; Shuichi Matsuda
Journal:  Orthop J Sports Med       Date:  2020-11-05

3.  Spontaneous osteonecrosis of the knee (SONK): The role of MR imaging in predicting clinical outcome.

Authors:  Rola Husain; Jared Nesbitt; Dharmesh Tank; Marco Oriundo Verastegui; Elaine S Gould; Mingqian Huang
Journal:  J Orthop       Date:  2020-11-19

4.  Biological Effects of High Tibial Osteotomy on Spontaneous Osteonecrosis of the Knee.

Authors:  Ken Kumagai; Shunsuke Yamada; Shuntaro Nejima; Masaichi Sotozawa; Yutaka Inaba
Journal:  Cartilage       Date:  2022 Jul-Sep       Impact factor: 3.117

5.  Fresh Osteochondral Allograft Transplantation for Spontaneous Osteonecrosis of the Knee: A Case Series.

Authors:  Luís E P Tírico; Samuel A Early; Julie C McCauley; William D Bugbee
Journal:  Orthop J Sports Med       Date:  2017-10-03

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

Authors:  Tao Yang; Huaming Xue; Tong Ma; Tao Wen; Long Xue; Mengyin Guan; Yihui Tu
Journal:  BMC Musculoskelet Disord       Date:  2020-08-31       Impact factor: 2.362

  6 in total

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