K. Nishitani (Kyoto, JP)
Kyoto University Department of Orthopaedic Surgery, Graduate School of MedicinePresenter Of 1 Presentation
18.1.8 - Long-term outcome of the autologous osteochondral transplantation for steroid induced osteonecrosis of the knee
Abstract
Purpose
The treatment of the steroid induced osteonecrosis of the knee is still challenging. The purpose of this study was to investigate the long-term survivorship and outcomes of the autologous osteochondral transplantation (AOT) for the steroid induced osteonecrosis of the knee.
Methods and Materials
Patients who underwent AOT due to the steroid induced osteonecrosis of the knee between 1998 and 2007 were included. The survivorship was evaluated with Kaplan-Meier method with the revision surgery on the transplanted cartilage as an end-point, and clinical outcomes were evaluated with the International Knee Documentation Committee (IKDC) subjective score and radiographical changes.
Results
Fourteen knees (medial femoral condyle in 5 cases, lateral in 9 cases) of 10 patients (2 males and 8 females) were enrolled. The mean age at the surgery was 32.5 ± 11.0 years-old. All patients were followed-up more than 10 years (14.2 ± 2.8 years, 10.4 -20.0 years). The primary diseases were systemic lupus erythematosus in 5 knees of 3 patients, idiopathic thrombocytopenic purpura in 3 knees of 2 patients, nephrosis syndrome in 3 knees of 2 patients, leukemia in 1 knee, IgA nephropathy in 1 knee, and andrelapsing polychondritis in 1 knee. The lesion size of 6.9 ± 2.8 cm2 was repaired using 3.9 ± 0.8 osteochondral plugs. Although there was no revision surgery for the failed cartilage repair and survival rate was 100 % at final follow-up, one case underwent arthroscopic removal of a loose body at 96 months. IKDC subjective score improved from 32.9 ± 13.4 to 74.3 ± 21.3 (p value < 0.001) at final follow-up. Although KL grade of femorotibial joint did not changed, the KL grade of patellofemoral joint deteriorated.
Conclusion
AOT is an effective surgery for the steroid induced osteonecrosis of the knee to avoid prosthetic joint replacement in young patients.