Osteonecrosis of the medial tibial plateau: a case report

Open-wedge high tibial osteotomy for spontaneous osteonecrosis of the medial tibial plateau shows excellent clinical outcomes

PurposeThere have been few reports on medial tibial plateau osteonecrosis, and treatment options remain controversial. This study aimed to evaluate the clinical outcomes of open-wedge high tibial osteotomy (OWHTO) for osteonecrosis of the medal tibial plateau.MethodsPatients who underwent OWHTO for spontaneous osteonecrosis of the medial tibial plateau from November 2013 to September 2017 at our institution and followed up for at least 2 years after surgery were included in this study. Patients with history of alcohol abuse and corticosteroid therapy were excluded. Clinical evaluations, including the Japanese Orthopedic Association (JOA) score and the Oxford Knee Score (OKS), were measured preoperatively and at the final followup. Radiological evaluations included the weight-bearing line ratio (WBLR) and the lesion stage of the osteonecrosis according to Carpintero, Lotke, and the modified Ficat and Arlet classification. The area and size of the necrosis and the type of meniscus tear were also evaluated using preoperative magnetic resonance imaging (MRI). Additionally, cartilage regeneration was evaluated at plate removal.ResultsTwelve cases that underwent OWHTO for spontaneous osteonecrosis of the medial tibial plateau were enrolled. Eleven cases had isolated medial tibial osteonecrosis, and one case had both femoral and tibial osteonecrosis. The mean age was 59.6 ± 9.0 years, and the mean follow-up period was 41.8 ± 17.6 months.The WBLR significantly changed after OWHTO (24.0% ± 10.7% to 66.3% ± 6.7%, P < 0.001), and all clinical scores significantly improved after surgery: JOA score 63.3 ±12.3 to 95.0 ± 4.8, OKS 27.4 ± 7.8 to 42.6 ± 4.1, both 0.001. There were no adverse complications requiring additional surgery. The MRI findings revealed that all cases had meniscal lesions in addition to a necrotic lesion. Second-look arthroscopy was performed at plate removal in 11 cases, and cartilage regeneration was observed in 9/11 cases (81.8%).ConclusionsThis study's results demonstrated that OWHTO is an effective procedure for spontaneous osteonecrosis of the medial tibial plateau with respect to subjective and objective clinical outcomes.

Complications following radiosynoviorthesis in osteoarthritis and arthroplasty: osteonecrosis and intra-articular infection

OBJECTIVES

In the literature, radiosynoviorthesis (RSO) has been associated only with a small number of complications. There is a trend towards increasing the use of RSO in diverse indications. After repeatedly observing several complications following RSO, a retrospective evaluation was undertaken to estimate the safety of this method.

METHODS

Between 1995-2007, we evaluated the outcome of RSO in 93 patients (143 knees, seven hips, seven shoulders, three elbows, one ankle) who presented to our orthopaedic department after joint treatment with yttrium-90((90)Y) or Rhenium-186((186)Re) colloid in an external nuclear medicine institution.

RESULTS

Seventy-nine of the 93 RSO treated patients had advanced primary or secondary osteoarthritis (OA), 12 had an arthroplasty. In seven cases, rheumatoid arthritis (RA) was responsible for secondary OA. The benefit in pain relief, as self-reported by the patients was low. Twenty-two of the 93 patients showed complications following RSO. We observed osteonecrosis (ON) in 19 and infection in five patients, including two with both complications. These findings were proven clinically, radiologically, intraoperatively, microbiologically and histologically. Statistical analysis revealed a strong correlation of arthroplasty to infection (rho=0.798, alpha=0.01), and a strong correlation of chronic obstructive pulmonary disease (COPD) and RA to ON following RSO (rho=0.674, alpha=0.01). Diabetes mellitus (DM) was also significantly correlated to ON after RSO treatment (rho=0.488,alpha=0.05).

CONCLUSIONS

Our data suggest that RSO may not be as safe as it has previously been reported, especially in advanced OA and arthroplasty.

Osteonecrosis of the knee: a review of three disorders

Osteonecrosis of the knee is a debilitating disease that is poorly understood. Originally described as a single disorder, it encompasses three distinct conditions: spontaneous osteonecrosis of the knee (SPONK), secondary osteonecrosis of the knee, and post-arthroscopic osteonecrosis of the knee. This article reviews the current knowledge of these distinct conditions by describing their etiology, pathology, and pathogenesis, as well as their clinical and radiographic presentations. The various treatment options available for each condition are reviewed, with a discussion of their rationale and indications, and a summary of results with various techniques. A thorough understanding of these conditions and their distinguishing features is critical to selecting the best treatment option for an individual patient.