Serrano Daniel Veloz, Saseendar Samundeeswari, Shanmugasundaram Saseendar, Bidwai Rohan, Gómez Diego, D'Ambrosi Riccardo
Hospital Britanico of Buenos Aires, Buenos Aires C1280 AEB, Argentina.
Apollo Hospital Muscat, Muscat 131, Oman.
J Clin Med. 2022 Nov 25;11(23):6943. doi: 10.3390/jcm11236943.
Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article's goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty.
骨坏死是一种严重的病症，可导致包括膝关节在内的多个关节出现晚期关节炎。可影响膝关节的三种骨坏死类型为继发性、关节镜检查后以及膝关节自发性骨坏死（SPONK）。无论骨坏死的分类如何，针对这种病症的治疗旨在预防进一步发展或推迟膝关节终末期关节炎的发作。每当出现明显的关节面塌陷或有退行性关节炎迹象时，关节置换术是最佳的治疗方法。目前的非手术治疗选择包括观察、非甾体类抗炎药（NSAIDs）、保护性负重以及必要时的镇痛。根据病情的严重程度和类型，手术程序可能包括单髁膝关节置换术（UKA）、全膝关节置换术（TKA）或关节保留手术。当关节软骨通常未受影响且仅下层软骨下骨受影响时，关节保留技术，如关节镜检查、髓芯减压、自体骨软骨移植和骨移植，常用于塌陷前和一些塌陷后的病变。相比之下，在严重的软骨下塌陷后试图挽救关节的手术很少成功，需要进行关节置换以缓解不适。本文的目的是总结关于膝关节骨坏死的评估、临床检查、影像学和各种治疗策略的最新研究，包括病变监测、药物、关节保留方法和全关节置换术。
