Nishit Bhatnagar1, Siddharth Sharma2,3, Virender Kumar Gautam1, Ajeet Kumar1, Anurag Tiwari4. 1. Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India. 2. Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, 2, Near Delhi Gate, Jawaharlal Nehru Marg, New Delhi, 110002, India. drsidd.ortho@gmail.com. 3. , Ghaziabad, India. drsidd.ortho@gmail.com. 4. Department of Orthopedics, All India Institute of Medical Sciences, Saket Nagar, Habib Ganj, Bhopal, Madhya Pradesh, 462026, India.
Abstract
PURPOSE: Spontaneous osteonecrosis of the knee affects the medial femoral condyle in patients above 55 years of age. Many reports and studies are available from western countries. But there is a gross paucity of literature on spontaneous osteonecrosis of the knee (SPONK) in the Indian subcontinent, either it is under-reported or detected at a later stage. The aim of our study was to detect SPONK in Indian population and describe its characteristics, treatment, and outcome. MATERIAL AND METHOD: A prospective study was conducted over a period of three years. All patients above 18 years with knee pain at rest and medial condyle tenderness without joint laxity were evaluated with plain radiographs and MRI. Further tests were done if radiological signs of osteonecrosis were present. Various parameters were recoded like Visual Analog Scale (VAS), Knee Society Score (KSS), and MRI Osteoarthritis Knee Score. Conservative treatment consisted of a combination of NSAIDs and bisphosphonates. Decompression with bone grafting was done if there was no improvement or deterioration at three month follow-up. RESULTS: Ten patients were diagnosed with SPONK. The mean age was 50 years with male predominance (60%) with the involvement of medial femoral condyle (80%) or left knee (70%). Most cases were in Koshino stage 1. Mean VAS was 6.5 and mean KSS was 59. All clinical parameters showed improvement at one year. DISCUSSION: A study with a bigger sample size and longer follow-up is needed to fill the lacunae of literature on this topic from the Indian subcontinent. In spite of the limitations, we did observe that in our population, males were more commonly affected than females, which is contrary to most studies on the subject. Also, the disease had an early age of onset (50 years) in Indian population as compared to Western and East Asian populations. CONCLUSION: Combined therapy of NSAIDs and bisphosphonates shows excellent results over a period of one year. Joint-preserving surgeries are effective even in Koshino stage 3 SPONK.
PURPOSE: Spontaneous osteonecrosis of the knee affects the medial femoral condyle in patients above 55 years of age. Many reports and studies are available from western countries. But there is a gross paucity of literature on spontaneous osteonecrosis of the knee (SPONK) in the Indian subcontinent, either it is under-reported or detected at a later stage. The aim of our study was to detect SPONK in Indian population and describe its characteristics, treatment, and outcome. MATERIAL AND METHOD: A prospective study was conducted over a period of three years. All patients above 18 years with knee pain at rest and medial condyle tenderness without joint laxity were evaluated with plain radiographs and MRI. Further tests were done if radiological signs of osteonecrosis were present. Various parameters were recoded like Visual Analog Scale (VAS), Knee Society Score (KSS), and MRI Osteoarthritis Knee Score. Conservative treatment consisted of a combination of NSAIDs and bisphosphonates. Decompression with bone grafting was done if there was no improvement or deterioration at three month follow-up. RESULTS: Ten patients were diagnosed with SPONK. The mean age was 50 years with male predominance (60%) with the involvement of medial femoral condyle (80%) or left knee (70%). Most cases were in Koshino stage 1. Mean VAS was 6.5 and mean KSS was 59. All clinical parameters showed improvement at one year. DISCUSSION: A study with a bigger sample size and longer follow-up is needed to fill the lacunae of literature on this topic from the Indian subcontinent. In spite of the limitations, we did observe that in our population, males were more commonly affected than females, which is contrary to most studies on the subject. Also, the disease had an early age of onset (50 years) in Indian population as compared to Western and East Asian populations. CONCLUSION: Combined therapy of NSAIDs and bisphosphonates shows excellent results over a period of one year. Joint-preserving surgeries are effective even in Koshino stage 3 SPONK.
Entities:
Keywords:
Conservative management; Decompression and bone grafting; Indian population; Outcomes; SPONK
Authors: Nyagon G Duany; Michael G Zywiel; Mike S McGrath; Junaed A Siddiqui; Lynne C Jones; Peter M Bonutti; Michael A Mont Journal: Arch Orthop Trauma Surg Date: 2010-01 Impact factor: 3.067
Authors: Philippe Hernigou; Benjamin Thiebaut; Victor Housset; Claire Bastard; Yasuhiro Homma; Younes Chaib; Charles Henri Flouzat Lachaniette Journal: Int Orthop Date: 2018-04-26 Impact factor: 3.075