Osteonecrosis is a bony infarction caused by disruption of blood supply to the bone. Osteonecrosis is divided into two main categories, primary (spontaneous, idiopathic) and secondary. The etiology of primary osteonecrosis remains unknown. Secondary causes include steroid therapy, systemic lupus erythematosus, alcoholism, sickle cell disease, and renal transplantation. Patients with osteonecrosis are typically elderly women who present with acute knee pain. The weight-bearing surface of the medial femoral condyle of the knee is the most common site of involvement. Physical exam generally reveals tenderness over the involved femoral condyle or tibial compartment. Secondary osteonecrosis occurs in a younger age group. Plain radiographs are typically normal early in the course of the disease but MR scanning is diagnostic. Initial treatment is nonoperative and consists of protected weight-bearing and the use of nonsteroidal anti-inflammatory drugs. The outcome of the disease depends on the percentage of the weight-bearing surface of the joint involved. Treatment options for advanced stages of the disease include arthroscopic debridement, curettage or drilling of the lesion, bone grafting, high tibial osteotomy, use of osteochondral allografts, and total knee arthroplasty.24
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