Skip to main content
SpringerLink
Log in

Le BMP-7 nel trattamento delle necrosi dei condili femorali

Bmp-7s for the treatment of osteonecrosis of the femoral condyles

  • Attuali Applicazioni Cliniche
  • Published:
Archivio di Ortopedia e Reumatologia

Abstract

Osteonecrosis of the femoral condyle is a well-recognized cause of spontaneous, acute, severe well-localised pain, usually at the antero-medial aspect of the knee joint. Treatment is conservative in the early stages. Surgical procedures include artroscopy, osteotomy, drilling of the lesion with or without bone grafting, allograft replacement and knee arthroplasty. Five patients diagnosed with osteonecrosis of the medial condyle were treated in our institute with core decompression and local application of growth factors (rhBMP-7). The patients were evaluated after 3, 6 and 12 months with objective evaluation, Knee Society Score and knee radiographs. Four knees were treated successfully, with no evidence of radiographic disease progression, and total knee replacement could be avoided. At 12 months’follow-up four patients report a satisfying outcome (Knee Society Score >80).

We believe this technique to be a safe and effective alternative to decrease pain and to avoid knee arthroplasty in the early stages of disease, although prosthetic replacement still remains the gold standard procedure in advanced cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Bibliografia

  1. Soucacos PN, Xenakis TH, Beris AE (1997) Idiopathic osteonecrosis of the medial femoral condyle. Classification and treatment. Clin Orthop 341:82–89

    PubMed  Google Scholar 

  2. Patel DV, Aichroth PM (1992) Osteonecrosis of the knee: an overview. In: Aichroth PM (Ed.) Knee surgery: current practice. Dunitz, London:450–455

    Google Scholar 

  3. Kitzinger KJ, Lotke PA (1992) Osteonecrosis of the knee. In: Aichroth PM (Ed.) Knee surgery: current practice. Dunitz, London: 456–463

    Google Scholar 

  4. Aglietti P, Insall JN, Buzzi R, Deschamps G (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone J Surg Br 65:588–597

    CAS  Google Scholar 

  5. Ahuja SC, Bullough PG (1978) Osteonecrosis of the kKnee. A clinicopathological study in twenty-eight patients. J Bone J Surg Am 60:191–197

    CAS  Google Scholar 

  6. Koshino T, Okamoto R, Takamura K, Tsuchiya K (1979) Arthroscopy in spontaneous osteonecrosis of the knee. Orthop Clin North Am 10:609–618

    CAS  PubMed  Google Scholar 

  7. Miller GK, Maylahn DJ, Drennan DB (1986) The treatment of idiopathic osteonecrosis of the medial femoral condyle with arthroscopic debridement. Arthroscopy 2:21–29

    Article  CAS  PubMed  Google Scholar 

  8. Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone J Surg Am 66:1040–1048

    CAS  Google Scholar 

  9. Koshino T (1982) The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bonegrafting or drilling of the lesion. J Bone J Surg Am 64:47–58

    CAS  Google Scholar 

  10. Ganel A, Israeli A, Horoszowski H, Farine I (1981) Osteochondral graft in the treatment of osteonecrosis of the femoral condyle. J Am Geriatr Soc 29:186–188

    CAS  PubMed  Google Scholar 

  11. Gross AE, McKee NH, Pritzker KP, Langer F (1983) Reconstruction of skeletal deficits at the knee. A comprehensive osteochondral transplant program. Clin Orthop 174:96–106

    PubMed  Google Scholar 

  12. Insall JN, Aglietti P, Bullough PG (1984) Osteonecrosis. In: Insall JN (Ed.) Surgery of the knee. Churchill Livingstone, New York:527–549

    Google Scholar 

  13. EMEA (2000) European public assessment report. Procedure: no EMEA/H/C/2293

  14. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop 248:13–14

    PubMed  Google Scholar 

  15. Bayne O, Langer F, Pritzker KP et al (1985) Osteochondral allografts in the treatment of osteonecrosis of the knee. Orthop Clin North Am 16:727–740

    CAS  PubMed  Google Scholar 

  16. Matsusue Y, Yamamuro T, Hama H (1993) Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption. Arthroscopy 9:318–321

    CAS  PubMed  Google Scholar 

  17. Hangody L, Kish G, Kárpáti Z, Eberhart R (1997) Osteochondral plugs: Autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral articular defects. Operative Techniques in Orthopaedics 7:312–322

    Article  Google Scholar 

  18. Attmanspacher W, Dittrich V, Stedtfeld HW (2000) Experiences with arthroscopic therapy of chondral and osteochondral defects of the knee joint with OATS (Osteochondral Autograft Transfer System). Zentralbl Chir 125:494–499

    CAS  PubMed  Google Scholar 

  19. Deie M, Ochi M, Adachi N et al (2008) Artificial bone grafting [calcium hydroxyapatite ceramic with an interconnected porous structure (IP-CHA)] and core decompression for spontaneous osteonecrosis of the femoral condyle in the knee. Knee Surg Sports Traumatol Arthrosc 16:753–758

    Article  PubMed  Google Scholar 

  20. Rozing PM, Insall J, Bohne WH (1980) Spontaneous osteonecrosis of the knee. J Bone J Surg Am 62:2–7

    CAS  Google Scholar 

  21. 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 J Surg Am 65:619–628

    CAS  Google Scholar 

  22. Forst J, Forst R, Heller KD, Adam G (1998) Spontaneous osteonecrosis of the femoral condyle: causal treatment by early core decompression. Arch Orthop Trauma Surg 117:18–22

    Article  CAS  PubMed  Google Scholar 

  23. Jacobs MA, Loeb PE, Hungerford DS (1989) Core decompression of the distal femur for avascular necrosis of the knee. J Bone Joint Surg Br 71:583–587

    CAS  PubMed  Google Scholar 

  24. Mont MA, Tomek IM, Hungerford DS (1997) Core decompression for avascular necrosis of the distal femur: long term followup. Clin Orthop 334:124–130

    PubMed  Google Scholar 

  25. Mont MA, Jones LC, Einhorn TA et al (1998) Osteonecrosis of the femoral head. Potential treatment with growth and differentiation factors. Clin Orthop 355[Suppl.]:314–335

    Google Scholar 

  26. Wozney JM (1989) Bone morphogenetic proteins. Prog Growth Factor Res 1:267–280

    Article  CAS  PubMed  Google Scholar 

  27. Gerstenfeld LC, Cullinane DM, Barnes GL et al (2003) Fracture healing as a post-natal developmental process: molecular, spatial, and temporal aspects of its regulation. J Cell Biochem 88:873–884

    Article  CAS  PubMed  Google Scholar 

  28. Giannoudis PV, Kanakaris NK, Einhorn TA (2007) Interaction of bone morphogenetic proteins with cells of the osteoclast lineage: review of the existing evidence. Osteoporos Int 18:1565–1581

    Article  CAS  PubMed  Google Scholar 

  29. Sakou T (1998) Bone morphogenetic proteins: from basic studies to clinical approaches. Bone 22:591–603

    Article  CAS  PubMed  Google Scholar 

  30. Cook SD, Barrack RL, Patron LP, Salkeld SL (2004) Osteogenic protein-1 in knee arthritis and arthroplasty. Clin Orthop 428:140–145

    Article  PubMed  Google Scholar 

  31. Friedlaender GE, Perry CR, Cole JD et al (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 83[Suppl. 1]:151–158

    Google Scholar 

  32. Harwood PJ, Giannoudis PV (2005) Application of bone morphogenetic proteins in orthopaedic practice: their efficacy and side effects. Expert Opin Drug Saf 4:75–89

    Article  CAS  PubMed  Google Scholar 

  33. Mont MA, Jones LC, Elias JJ et al (2001) Strut-autografting with and without osteogenic protein- 1: a preliminary study of a canine femoral head defect model. J Bone Joint Surg Am 83:1013–1022

    PubMed  Google Scholar 

  34. Lieberman JR, Conduah A, Urist MR (2004) Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop 429:139–145

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centro di Chirurgia Ortopedica Riparativa e Risk Management, Istituto Ortopedico G.Pini, Università degli Studi di Milano, Milano, Italy

    G. M. Calori & L. Tagliabue

  2. Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milano, Italy

    C. Legnani

Authors
  1. G. M. Calori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Legnani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Tagliabue
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Calori, G.M., Legnani, C. & Tagliabue, L. Le BMP-7 nel trattamento delle necrosi dei condili femorali. Arch Ortop Reumatol 120, 40–41 (2009). https://doi.org/10.1007/s10261-009-0053-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10261-009-0053-4

Search

Navigation