Fresh Osteochondral Allografting for Steroid-associated Osteonecrosis of the Femoral Condyles
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Osteonecrosis is a complication of corticosteroid therapy with limited treatment options in young, active patients. These options include debridement, core decompression, osteotomy, allografting, and partial or total knee replacement. Few studies exist regarding the use of osteochondral allografts for treatment of steroid-associated osteonecrosis.
We asked if fresh osteochondral allografts would (1) heal to host bone in the presence of osteonecrosis, (2) provide a clinically meaningful decrease in pain and improvement in function, and (3) prevent or postpone the need for prosthetic arthroplasty.
Patients and Methods
Twenty-two patients (28 knees) who underwent osteochondral allografting for high-grade, corticosteroid-associated osteonecrosis were evaluated. Their average age was 24.3 years (range, 16–44 years). The mean graft surface area was 10.8 cm2 (range, 5.0–19.0 cm2). Evaluation included a modified (for the knee) D’Aubigné and Postel (18-point) score, International Knee Documentation Committee (IKDC), and Knee Society function scores. The minimum followup was 25 months (mean, 67 months; range, 25–235 months).
Five knees failed. The graft survival rate was 89% (25 of 28). The mean D’Aubigné and Postel score improved from 11.3 to 15.8; 19 of 25 (76%) had a score greater than 15. The mean IKDC pain score improved from 7.1 to 2.0, mean IKDC function score from 3.5 to 8.3, and mean Knee Society function score from 60.0 to 85.7.
Our data suggest osteochondral allografting is a reasonable salvage option for osteonecrosis of the femoral condyles. TKA was avoided in 27 of the 28 of knees at last followup.
Level of Evidence
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
- Anderton JM, Helm R. Multiple joint osteonecrosis following short-term steroid therapy: case report. J Bone Joint Surg Am. 1982;64:139–141.
- Bayne O, Langer F, Pritzker KP, Houpt J, Gross AE. Osteochondral allografts in the treatment of osteonecrosis of the knee. Orthop Clin North Am. 1985;16:727–740.
- D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.
- Fisher DE, Bickel WH. Corticosteroid-induced avascular necrosis: a clinical study of seventy-seven patients. J Bone Joint Surg Am. 1971;53:859–873.
- Flynn JM, Springfield DS, Mankin HJ. Osteoarticular allografts to treat distal femoral osteonecrosis. Clin Orthop Relat Res. 1994;303:38–43.
- Görtz S, Bugbee WD. Allografts in articular cartilage repair. J Bone Joint Surg Am. 2006;88:1374–1384.
- Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.
- Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001;29:600–613.
- Koshino T. The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion. J Bone Joint Surg Am. 1982;64:47–58.
- Koshino T, Okamoto R, Takamura K, Tsuchiya K. Arthroscopy in spontaneous osteonecrosis of the knee. Orthop Clin North Am. 1979;10:609–618.
- Marulanda G, Seyler TM, Sheikh NH, Mont MA. Percutaneous drilling for the treatment of secondary osteonecrosis of the knee. J Bone Joint Surg Br. 2006;88:740–746. CrossRef
- Mont MA, Baumgarten KM, Rifai A, Bluemke DA, Jones LC, Hungerford DS. Atraumatic osteonecrosis of the knee. J Bone Joint Surg Am. 2000;82:1279–1290.
- Mont MA, Glueck CJ, Pacheco IH, Wang P, Hungerford DS, Petri M. Risk factors for osteonecrosis in systemic lupus erythematosus. J Rheumatol. 1997;24:654–662.
- Mont MA, Rifai A, Baumgarten KM, Sheldon M, Hungerford DS. Total knee arthroplasty for osteonecrosis. J Bone Joint Surg Am. 2002;84:599–603.
- Seldes RM, Tan V, Duffy G, Rand JA, Lotke PA. Total knee arthroplasty for steroid-induced osteonecrosis. J Arthroplasty. 1999;14:533–537. CrossRef
- Fresh Osteochondral Allografting for Steroid-associated Osteonecrosis of the Femoral Condyles
Clinical Orthopaedics and Related Research®
Volume 468, Issue 5 , pp 1269-1278
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
- 2. Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, CA, USA
- 3. Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA, 92037, USA