Fresh Osteochondral Allografting for Steroid-associated Osteonecrosis of the Femoral Condyles

Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 02/2010; 468(5):1269-78. DOI: 10.1007/s11999-010-1250-7
Source: PubMed


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.
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 cm(2) (range, 5.0-19.0 cm(2)). 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 IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Download full-text


Available from: William D Bugbee, Apr 29, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Young patients with early osteoarthritis (OA) represent a challenging population due to a combination of high functional demands and limited treatment options. Conservative measures such as injection and physical therapy can provide short-term pain relief but are only palliative in nature. Joint replacement, a successful procedure in the older population, is controversial in younger patients, who are less satisfied and experience higher failure rates. Therefore, while traditionally not indicated for the treatment of OA, cartilage repair has become a focus of increased interest due to its potential to provide pain relief and alter the progression of degenerative disease, with the hope of delaying or obviating the need for joint replacement. The field of cartilage repair is seeing the rapid development of new technologies that promise greater ease of application, less demanding rehabilitation and better outcomes. Concurrent procedures such as meniscal transplantation and osteotomy, however, remain of crucial importance to provide a normalized biomechanical environment for these new technologies. Level of evidence Systematic review, Level II.
    Full-text · Article · Nov 2011 · Knee Surgery Sports Traumatology Arthroscopy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: O tratamento das lesões condrais e osteocondrais do joelho em pacientes jovens ainda permanece um desafio para os ortopedistas. As técnicas de reparo atualmente disponíveis no Brasil, como o desbridamento, microfraturas e transplante osteocondral autólogo são insuficientes nos tratamentos de lesões condrais e osteocondrais grandes. O transplante osteocondral homólogo a fresco (TOF) na articulação do joelho vem sendo usado nos Estados Unidos com excelentes resultados. Este artigo tem o intuito de revisar a ciência básica, indicações, técnicas cirúrgicas, possíveis complicações e descrever a técnica de transplante osteocondral homólogo a fresco na articulação do joelho realizada no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo.
    Full-text · Article · Dec 2011 · Revista Brasileira de Ortopedia
  • [Show abstract] [Hide abstract]
    ABSTRACT: Osteochondrale Allografts werden in einigen Ländern seit vielen Jahren zur Behandlung osteochondraler Knorpeldefekte verwendet. Entnahme, Verarbeitung und Vertrieb osteochondraler Allografts werden seit dem Ende der 1990er Jahre in den USA erfolgreich durchgeführt. Klinische Ergebnisse zeigen, dass diese Transplantate gute Langzeitresultate aufweisen und eine gute Lösung für schwer zu behandelnde kombinierte chondrale und ossäre Gelenkdefekte darstellen. Eine osteochondrale Allografttransplantation ist bis dato die einzige Technik, mit der große Gelenkdefekte mit hyalinem Knorpel rekonstruiert werden können. In diesem Übersichtsartikel wird auf den Hintergrund der osteochondralen Allografttransplantation und auf die verschiedenen Operationstechniken und zu erzielenden Resultate eingegangen. Abstract Osteochondral allografts have become increasingly more popular in several countries throughout the last decade. It appears that long-term results of this technique are favorable even in patients with severe joint defects. Osteochondral allograft transplantation is to date the only technique that is able to restore hyaline cartilage of large osteochondral defects in a structurally appropriate manner. In this article the background to osteochondral allograft transplantation and the different operative techniques and the outcomes will be discussed.
    No preview · Article · Feb 2012 · Arthroskopie
Show more