Abstract
Spontaneous osteonecrosis of the knee (SON) is an osteonecrosis that mainly affects the medial femoral condyle. In endstage SON, knee arthroplasty is the therapy of choice. Because of the unicompartimental nature of the knee, unicondylar knee arthroplasty is considered an ideal implant for treatment of this condition. The purpose of this study was to prove that the long-term results of unicondylar implants are better than the results of bicondylar implants for the treatment of SON. All patients treated for SON between 1984 and 2000 have been recorded. Two groups were formed according to the implant used. In all patients the preoperative radiograph was analyzed according to stage and size of the osteonecrotic lesion and the osteoarthritic changes. Postoperatively, the Knee Society Score and the radiograph were recorded. Thirty-nine patients were included in this study, of which 23 patients were treated by a unicondylar implant and 16 by a bicondylar implant. On a short-term basis, unicondylar implants had better clinical results; however, on a long-term basis bicondylar implants were better. In comparison, only unicondylar implants had to be revised. Radiolucency lines were mainly observed in patients with unicondylar impants and large areas of osteonecrosis. Our long-term results suggest that patients with SON are better treated by bicondylar implants. The reasons for the higher failure rate for unicondylar implants are poor bone stock and secondary arthritic changes.
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References
Aglietti P, Insall JN, Buzzi R, Deschamps G (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg Br 655:588–597
Ahlback S, Bauer GC, Bohne WH (1968) Spontaneous osteonecrosis of the knee. Arthritis Rheum 116:705–733
Bergman NR, Rand JA (1991) Total knee arthroplasty in osteonecrosis. Clin Orthop 273:77–82
Bernasek TL, Rand JA, Bryan RS (1988) Unicompartmental porous coated anatomic total knee arthroplasty. Clin Orthop 236:52–59
Cartier P, Gaggiotti G, Jully JL (1988) Primary osteonecrosis of the medial femoral condyle. Unicompartmental or total replacement? Int Orthop 123:229–235
Chesnut WJ (1991) Preoperative diagnostic protocol to predict candidates for unicompartmental arthroplasty. Clin Orthop 273:146–150
Christensen NO (1991) Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital. Clin Orthop 273:165–169
Deshmukh RV, Scott RD (2001) Unicompartmental knee arthroplasty: long-term results. Clin Orthop 392:272–278
Engh GA (2002) Orthopaedic crossfire–can we justify unicondylar arthroplasty as a temporizing procedure? in the affirmative. J Arthroplasty 174(Suppl 1):54–55
Hermichen HG, Wentzensen A, Meeder PJ, Weller S (1988) Treatment of necrosis of the femur condyle with a medial gliding knee prosthesis. Z Orthop Ihre Grenzgeb 1263:300–303
Insall J, Scott WN, Ranawat CS (1979) The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 612:173–180
Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am 655:619–628
Jones WT, Bryan RS, Peterson LF, Ilstrup DM (1981) Unicompartmental knee arthroplasty using polycentric and geometric hemicomponents. J Bone Joint Surg Am 636:946–954
Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 711:145–150
Laskin RS (2001) Unicompartmental knee replacement: some unanswered questions. Clin Orthop 392:267–271
Lotke PA, Abend JA, Ecker ML (1982) The treatment of osteonecrosis of the medial femoral condyle. Clin Orthop 171:109–116
Marmor L (1993) Unicompartmental arthroplasty for osteonecrosis of the knee joint. Clin Orthop 294:247–253
Marmor L (1993) Unicompartmental arthroplasty for osteonecrosis of the knee joint. Clin Orthop 294:247–253
Muheim G, Bohne WH (1970) Prognosis in spontaneous osteonecrosis of the knee. Investigation by radionuclide scintimetry and radiography. J Bone Joint Surg Br 524:605–612
Ritter MA, Eizember LE, Keating EM, Faris PM (1991) The survival of total knee arthroplasty in patients with osteonecrosis of the medial condyle. Clin Orthop 267:108–114
Rozing PM, Insall J, Bohne WH (1980) Spontaneous osteonecrosis of the knee. J Bone Joint Surg Am 621:2–7
Scott RD, Cobb AG, McQueary FG, Thornhill TS (1991) Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop 271:96–100
Sculco TP (2002) Orthopaedic crossfire–can we justify unicondylar arthroplasty as a temporizing procedure? in opposition. J Arthroplasty 174 Suppl 1:56–58
Soucacos PN, Xenakis TH, Beris AE, Soucacos PK, Georgoulis A (1997) Idiopathic osteonecrosis of the medial femoral condyle. Classification and treatment. Clin Orthop 341:82–89
Stern SH, Becker MW, Insall JN (1993) Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop 286:143–148
Swank M, Stulberg SD, Jiganti J, Machairas S (1993) The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis. Clin Orthop 286:130–142
Tabor OB, Jr., Tabor OB (1998) Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty 134:373–379
Tapper EM, Hoover NW (1969) Late results after meniscectomy. J Bone Joint Surg Am 513:517–526
Wirth CJ, Stukenborg-Colsman C, Wefer A (1998) Osteonecrosis of the femoral condyle. Orthopade 277:501–507
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Radke, S., Wollmerstedt, N., Bischoff, A. et al. Knee arthroplasty for spontaneous osteonecrosis of the knee: unicompartimental vs bicompartimental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13, 158–162 (2005). https://doi.org/10.1007/s00167-004-0551-3
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DOI: https://doi.org/10.1007/s00167-004-0551-3