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Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate A prospective case series with 17 patients

Juréus, Jan LU ; Lindstrand, Anders LU ; Geijer, Mats LU ; Roberts, David LU and Tägil, Magnus LU (2012) In Acta Orthopaedica 83(5). p.511-514
Abstract
Background and purpose Primary spontaneous osteonecrosis of the knee is a painful lesion in the elderly without any known cause. The onset of pain is usually acute. The prognosis is poor with high frequency of osteoarthritis, joint surface collapse, and subsequent knee surgery. In the present study, we determined whether bisphosphonates can prevent the joint surface collapse by delaying the post-necrotic remodeling. Patients and methods Between 2006 and 2009, 17 consecutive patients (mean age 68 years) with clinical and radiographic signs of knee osteonecrosis were identified and given alendronate, 70 mg perorally, once a week for a minimum of 6 months. The patients were followed clinically, radiographically, and by MRI. Results 10 of the... (More)
Background and purpose Primary spontaneous osteonecrosis of the knee is a painful lesion in the elderly without any known cause. The onset of pain is usually acute. The prognosis is poor with high frequency of osteoarthritis, joint surface collapse, and subsequent knee surgery. In the present study, we determined whether bisphosphonates can prevent the joint surface collapse by delaying the post-necrotic remodeling. Patients and methods Between 2006 and 2009, 17 consecutive patients (mean age 68 years) with clinical and radiographic signs of knee osteonecrosis were identified and given alendronate, 70 mg perorally, once a week for a minimum of 6 months. The patients were followed clinically, radiographically, and by MRI. Results 10 of the 17 patients did not develop osteoarthritis (group A), 4 patients developed mild osteoarthritis but no knee joint surface collapse (group B), and 3 patients had a joint surface collapse (group C). 2 of the 3 patients in group C-as compared to none in the other groups-stopped medication prematurely, due to side effects. Interpretation Compared to a previous, untreated series of osteonecrosis patients at our hospital, the clinical results in the present series appeared better. 59% of the patients had a complete radiographic recovery, as compared to 25% in the original study. 12% were failures regarding need to undergo surgery when bisphosphonates were given, as compared to 32% in the previous untreated series. An anticatabolic drug delaying the remodeling might be an effective treatment in osteonecrosis of the knee but further (preferably randomized) studies are necessary. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
83
issue
5
pages
511 - 514
publisher
Taylor & Francis
external identifiers
  • wos:000310015700013
  • scopus:84867886579
ISSN
1745-3682
DOI
10.3109/17453674.2012.729184
language
English
LU publication?
yes
id
835a6578-6f3e-47a0-9ba4-9b2c08277847 (old id 3287568)
date added to LUP
2013-01-07 09:43:28
date last changed
2017-08-06 04:03:17
@article{835a6578-6f3e-47a0-9ba4-9b2c08277847,
  abstract     = {Background and purpose Primary spontaneous osteonecrosis of the knee is a painful lesion in the elderly without any known cause. The onset of pain is usually acute. The prognosis is poor with high frequency of osteoarthritis, joint surface collapse, and subsequent knee surgery. In the present study, we determined whether bisphosphonates can prevent the joint surface collapse by delaying the post-necrotic remodeling. Patients and methods Between 2006 and 2009, 17 consecutive patients (mean age 68 years) with clinical and radiographic signs of knee osteonecrosis were identified and given alendronate, 70 mg perorally, once a week for a minimum of 6 months. The patients were followed clinically, radiographically, and by MRI. Results 10 of the 17 patients did not develop osteoarthritis (group A), 4 patients developed mild osteoarthritis but no knee joint surface collapse (group B), and 3 patients had a joint surface collapse (group C). 2 of the 3 patients in group C-as compared to none in the other groups-stopped medication prematurely, due to side effects. Interpretation Compared to a previous, untreated series of osteonecrosis patients at our hospital, the clinical results in the present series appeared better. 59% of the patients had a complete radiographic recovery, as compared to 25% in the original study. 12% were failures regarding need to undergo surgery when bisphosphonates were given, as compared to 32% in the previous untreated series. An anticatabolic drug delaying the remodeling might be an effective treatment in osteonecrosis of the knee but further (preferably randomized) studies are necessary.},
  author       = {Juréus, Jan and Lindstrand, Anders and Geijer, Mats and Roberts, David and Tägil, Magnus},
  issn         = {1745-3682},
  language     = {eng},
  number       = {5},
  pages        = {511--514},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate A prospective case series with 17 patients},
  url          = {http://dx.doi.org/10.3109/17453674.2012.729184},
  volume       = {83},
  year         = {2012},
}