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The Journal of Bone and Joint Surgery (American) 84:599-603 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Total Knee Arthroplasty for Osteonecrosis

Michael A. Mont, MD, Aiman Rifai, DO, Keith M. Baumgarten, MD, Michael Sheldon, PA and David S. Hungerford, MD

Investigation performed at the Department of Orthopedic Surgery, The Johns Hopkins Medical Institute, Baltimore, Maryland

Michael A. Mont, MD
Sinai Hospital of Baltimore, Sinai Medical Office Building, Suite 102, 2411 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M. Mont: rhondamont{at}aol.com

Aiman Rifai, DO
Keith M. Baumgarten, MD
David S. Hungerford, MD
Department of Orthopedic Surgery, The Johns Hopkins Medical Institute, Baltimore, MD 21287

Michael Sheldon, PA
Stryker-Howmedica-Osteonics, 59 Route 17, Allendale, NJ 07401

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker-Howmedica-Osteonics. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Stryker-Howmedica-Osteonics). Also, a commercial entity (Stryker-Howmedica-Osteonics) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A patient with collapse of a femoral condyle caused by osteonecrosis has few treatment options other than total knee arthroplasty. The purpose of this study was to report the clinical and radiographic outcome of total knee arthroplasty for osteonecrosis.

Methods: Between 1987 and 1996, thirty-two total knee arthroplasties were performed with cement in thirty patients with osteonecrosis of the femoral condyle and/or tibial plateau. The study group included twenty-forty women and five men with a mean age of fifty-four years (range, thirty-one to seventy-seven years) at the time of the arthroplasty. Twenty-two patients had atraumatic osteonecrosis associated with corticosteroid use, and eight had spontaneous osteonecrosis. All patients had a complete clinical and radiographic evaluation at a mean of 108 months (range, forty-eight to 144 months) postoperatively.

Results: Overall, thirty-one (97%) of the thirty-two knees had a successful clinical outcome. The mean Knee Society score improved from 54 points preoperatively to 95 points at the time of the latest follow-up. No evidence of progressive radiolucency was found around any prosthetic component.

Conclusions: Previous studies have demonstrated less-than-optimal results following total knee arthroplasty in patients with osteonecrosis. The excellent results found in the present study may have been secondary to the use of cemented implants in all cases and ancillary stems when appropriate.


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