Rajashekhar K T, Mangsuli Kartik, Bhat Adarsh Krishna K
Department of Orthopaedics, Orthopaedics and Joint Replacement Surgery, Apollo Hospitals, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2025 Jun;15(6):168-173. doi: 10.13107/jocr.2025.v15.i06.5704.
Femoral condyle osteonecrosis of the knee leading to osteoarthritis is a rare entity, which is noticed more commonly in elderly women. Usually, the medial condyle is involved; lateral condyle involvement is extremely rare. Cases like these with occurrence in young individuals are even more rare and need thorough pre-operative evaluation, patient counseling, and intraoperative correlation for proper line of management. Based on the size and stage of the lesion, treatment options vary from medical management to biological therapies to arthroplasty in advanced cases.
A 17-year-old male with a body mass index of 29.6 presented to our outpatient clinic with complaints of pain over the left knee, difficulty in walking, squatting, and sitting cross-legged. He was examined clinically, radiologically, and intraoperatively based on the findings and was diagnosed with osteonecrosis of the lateral femoral condyle femur extending into the trochlea with arthritic changes. After detailed discussion and counseling with the patient and relatives, keeping in mind the patient's demand and expectations, he underwent robotic-assisted total knee arthroplasty (TKA).
Knee osteonecrosis is a debilitating, progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only management option is TKA.
Osteonecrosis of the knee in young patients, particularly when there is extensive articular involvement and associated osteoarthritic changes, is quite challenging to treat. Although joint preservation is typically preferred in younger individuals, TKA may be the only viable option in advanced stages to restore function and quality of life. Robotic-assisted TKA allows for precise implant positioning and optimal alignment and thus enhances the functional outcome. Individualized treatment planning, thorough pre-operative evaluation, and comprehensive patient counseling are essential to achieving successful outcomes in such rare and complex cases.
导致骨关节炎的膝关节股骨髁骨坏死是一种罕见病症，在老年女性中更为常见。通常，内侧髁受累；外侧髁受累极为罕见。在年轻个体中发生的此类病例更为罕见，需要进行全面的术前评估、患者咨询以及术中关联，以确定合适的治疗方案。根据病变的大小和阶段，治疗选择从药物治疗到生物疗法，在晚期病例中则为关节成形术。
一名体重指数为29.6的17岁男性因左膝疼痛、行走、下蹲和盘腿坐困难前来我院门诊就诊。根据检查结果对其进行了临床、放射学和术中检查，诊断为股骨外侧髁骨坏死并累及滑车，伴有关节炎改变。在与患者及其亲属进行详细讨论和咨询后，考虑到患者的需求和期望，他接受了机器人辅助全膝关节置换术（TKA）。
膝关节骨坏死是一种使人衰弱的进行性退行性疾病，其特征为软骨下骨缺血。它可导致局部坏死、组织死亡和关节的渐进性破坏。因此，早期诊断和治疗这种疾病对于避免软骨下塌陷、软骨损伤以及终末期骨关节炎至关重要，在终末期骨关节炎中唯一的治疗选择是TKA。
年轻患者的膝关节骨坏死，尤其是当存在广泛的关节受累和相关的骨关节炎改变时，治疗颇具挑战性。尽管年轻个体通常更倾向于保留关节，但在晚期阶段TKA可能是恢复功能和生活质量的唯一可行选择。机器人辅助TKA可实现精确的植入物定位和最佳对线，从而提高功能结果。个体化的治疗计划、全面的术前评估以及全面的患者咨询对于在此类罕见且复杂的病例中取得成功结果至关重要。
