Osteonecrosis of the Knee


Osteonecrosis of the knee is a rare disease classified into three types—secondary, spontaneous, and postarthroscopic—which are distinguished by location, condyles involved, patient age, symptoms, and associated risk factors. Plain radiography as well as MRI should be performed for correct diagnosis and staging of the disease, using the modified Ficat and Arlet system. Patients with early-stage spontaneous osteonecrosis or postarthroscopic osteonecrosis of the knee (Ficat and Arlet stages I and II) can usually be successfully treated with nonsurgical or joint-preserving management, including arthroscopy, bone grafting, core decompression, or high tibial osteotomy. In patients with late-stage disease with severe degenerative changes (Ficat and Arlet stages III and IV), or those with symptomatic secondary osteonecrosis, a unicompartmental or total knee arthroplasty is recommended.

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