The knee is the largest and most complex joint of the human body. Osteonecrosis, namely, the absence of blood supply of the bone leading to its “death”, mainly appears in three regions, called the osteonecrotic triad of the knee: the condyles of the femur, the patella and the tibial condyles. However, the medial condyle of the femur, the round portion at the distal end of the femur, is the most “sensitive” one.

Data from the American Academy of Orthopedic Surgeons show that women are three times more likely to develop this necrotic lesion, than men. They are mainly aged over 60, and they report pain in the inside of the knee (medial knee) (a pain which becomes more intense in the evening), swelling and sensitivity.
At first, X-rays show no pathological findings, and good knee mobility can “deceive” the medical examiner. This is the first stage of the disease, out of a total of four, which are described in literature. Next, the condyle of the femur begins to become flatter, a lesion that an MRI can show. When knee osteonecrosis is at the third stage, the damage of the articular cartilage can be observed, even through a simple x-ray. If the patient reaches the fourth stage then we are talking about severe degenerative osteoarthritis, which extends both in the medial and lateral knee compartments.
To date, studies have not responded to why the subchondral bone that drags the cartilage down to wear, begins to necrose. According to one view, reduced blood supply to the bone is a combination of a strain fracture with a specific activity, or an injury. Another view “accuses” the accumulation of fluid in the bone, resulting in the exertion of pressure upon the blood vessels. However, we are aware that knee necrosis is associated with obesity, sickle cell anemia, lupus, kidney transplantation and steroid therapy - the latter mainly involves young patients and it is observed in multiple joints.

At the early stages, when the affected area is small, the condition is treated conservatively, with medication, change of activities, crutches for the relief of the joint, and a muscle strengthening programme. However, if at least 50% of the joint surface is affected, then surgery is required.
Among the available options, which the surgeon shall discuss with the patient, are: an arthroscopic lavage of the joint, trepanning of the joint surface, in order to reduce pressure, osteotomies, in order to shift the load away from the affected area - and especially in older patients – and the partial or total replacement of the knee joint with an artificial one (unicompartmental or total knee replacement).

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