University of California San Diego School of Medicine, La Jolla, CA, USA.
Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA.
Cartilage. 2021 Jan;12(1):24-30. doi: 10.1177/1947603518809399. Epub 2018 Oct 31.
No studies currently exist with long-term follow-up of use of osteochondral allografting (OCA) for treatment of steroid-associated osteonecrosis of femoral condyles in young, active patients who wish to avoid total knee arthroplasty (TKA). We evaluate the extent to which fresh osteochondral allografts can (1) prevent or postpone need for prosthetic arthroplasty and (2) maintain long-term clinically meaningful decrease in pain and improvement in function at mean 11-year follow-up.
Twenty-five patients (33 knees) who underwent OCA transplantation for osteonecrosis of the knee between 1984 and 2013 were evaluated, including 22 females and 11 males with average age of 25 years (range, 16-48 years). Mean total allograft surface area was 10.6 cm (range, 4.0-19.0 cm). Evaluation included International Knee Documentation Committee (IKDC) scores, Knee Society function (KS-F) score, and modified (for the knee) Merle d'Aubigné-Postel (18-point) score.
OCA survivorship was 90% at 5 years and 82% at 10 years. Twenty-eight of 33 knees (85%) avoided arthroplasty and 25 of 33 knees (73%) avoided other surgical intervention. Mean IKDC pain score improved ( = 0.001) from 7.2 preoperatively to 2.8 at latest follow-up, mean IKDC function score increased ( = 0.005) from 3.3 to 6.5, and mean IKDC total score improved ( = 0.001) from 31.9 to 61.1. Mean KS-F score improved ( = 0.003) from 61.7 to 87.5. Mean modified Merle d'Aubigné-Postel (18-point) score improved ( < 0.001) from 11.4 to 15.1.
Our findings suggest that OCA transplantation is a reasonable surgical treatment option for steroid-associated osteonecrosis of the femoral condyles, with durable long-term outcomes.
目前尚无长期随访研究报告使用同种异体骨软骨移植术（OCA）治疗年轻、活跃的、希望避免全膝关节置换术（TKA）的类固醇相关性股骨髁骨坏死的疗效。我们评估了新鲜同种异体骨软骨移植物（1）预防或推迟假体关节置换的程度，以及（2）在平均 11 年随访时维持长期有临床意义的疼痛减轻和功能改善的程度。
1984 年至 2013 年间，我们对 25 例（33 膝）因膝骨坏死接受 OCA 移植的患者进行了评估，包括 22 名女性和 11 名男性，平均年龄 25 岁（16-48 岁）。平均总移植物表面积为 10.6cm（4.0-19.0cm）。评估包括国际膝关节文献委员会（IKDC）评分、膝关节协会功能（KS-F）评分和改良（膝关节）Merle d'Aubigné-Postel（18 分）评分。
5 年时 OCA 的存活率为 90%，10 年时为 82%。33 膝中的 28 膝（85%）避免了关节置换，33 膝中的 25 膝（73%）避免了其他手术干预。平均 IKDC 疼痛评分从术前的 7.2 分（ = 0.001）改善到最后随访时的 2.8 分，平均 IKDC 功能评分从 3.3 分（ = 0.005）增加到 6.5 分，平均 IKDC 总分从 31.9 分（ = 0.001）提高到 61.1 分。KS-F 评分从 61.7 分（ = 0.003）提高到 87.5 分。改良的 Merle d'Aubigné-Postel（18 分）评分从 11.4 分（ < 0.001）提高到 15.1 分。
我们的研究结果表明，同种异体骨软骨移植术是治疗类固醇相关性股骨髁骨坏死的一种合理的手术治疗选择，具有持久的长期疗效。
