Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)

Introduction: Secondary osteonecrosis of the knee affects younger population and has bilateral and extensive lesions. There is lack of evidence and a systematic review of literature on the treatment options is warranted. We aimed at identifying and analysing treatment options for secondary osteonecr...

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Main Authors: Vinay Joseph, Joseph Boktor, Stefan Bajada, Ben Coupe
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:Journal of Orthopaedic Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2773157X25000943
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author Vinay Joseph
Joseph Boktor
Stefan Bajada
Ben Coupe
author_facet Vinay Joseph
Joseph Boktor
Stefan Bajada
Ben Coupe
author_sort Vinay Joseph
collection DOAJ
description Introduction: Secondary osteonecrosis of the knee affects younger population and has bilateral and extensive lesions. There is lack of evidence and a systematic review of literature on the treatment options is warranted. We aimed at identifying and analysing treatment options for secondary osteonecrosis. Methods: A systematic review of literature was performed in accordance with the Cochrane handbook and reported according to the PRISMA guidelines. Analysis was performed using strategy of proportional meta-analysis. Results: A total of six studies were included with data on 240 knee joints in 192 patients were analysed. Follow up period ranged from 1 to 16 years. The mean age was 34.7. Three studies were on arthroplasty and three on joint preserving interventions. Steroid induced osteonecrosis was the majority. The pooled analysis showed an improvement of pre-operative knee score from 50.47 to 89.21 post-operatively. The pooled effect size for failure rate was 8.7 % in joint preserving interventions and 9.2 % in joint replacement group. Conclusion: Secondary knee osteonecrosis poses a therapeutic dilemma especially in early stages of osteonecrosis. Both joint preserving and joint replacement interventions do not show any significant or unacceptable complications. The results of this study will aid clinicians in the shared decision making process.
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spelling doaj-art-2f5a4a56d3ae4bfd918c1e35e6dbb30d2025-08-26T04:14:48ZengElsevierJournal of Orthopaedic Reports2773-157X2025-08-014210064210.1016/j.jorep.2025.100642Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)Vinay Joseph0Joseph Boktor1Stefan Bajada2Ben Coupe3Registrar, Trauma and Orthopaedics, Wales Deanery, UK; Corresponding author.Registrar, Trauma and Orthopaedics, Wales Deanery, UKOrthopaedic Surgeon, Hywel Dda University, UKOrthopaedic Surgeon, Soft Tissue Knee and Sports Knee Surgery, Wrightington Hospital, UKIntroduction: Secondary osteonecrosis of the knee affects younger population and has bilateral and extensive lesions. There is lack of evidence and a systematic review of literature on the treatment options is warranted. We aimed at identifying and analysing treatment options for secondary osteonecrosis. Methods: A systematic review of literature was performed in accordance with the Cochrane handbook and reported according to the PRISMA guidelines. Analysis was performed using strategy of proportional meta-analysis. Results: A total of six studies were included with data on 240 knee joints in 192 patients were analysed. Follow up period ranged from 1 to 16 years. The mean age was 34.7. Three studies were on arthroplasty and three on joint preserving interventions. Steroid induced osteonecrosis was the majority. The pooled analysis showed an improvement of pre-operative knee score from 50.47 to 89.21 post-operatively. The pooled effect size for failure rate was 8.7 % in joint preserving interventions and 9.2 % in joint replacement group. Conclusion: Secondary knee osteonecrosis poses a therapeutic dilemma especially in early stages of osteonecrosis. Both joint preserving and joint replacement interventions do not show any significant or unacceptable complications. The results of this study will aid clinicians in the shared decision making process.http://www.sciencedirect.com/science/article/pii/S2773157X25000943
spellingShingle Vinay Joseph
Joseph Boktor
Stefan Bajada
Ben Coupe
Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
Journal of Orthopaedic Reports
title Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
title_full Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
title_fullStr Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
title_full_unstemmed Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
title_short Treatment options for secondary osteonecrosis of the knee in young adults (Systematic review and meta-analysis)
title_sort treatment options for secondary osteonecrosis of the knee in young adults systematic review and meta analysis
url http://www.sciencedirect.com/science/article/pii/S2773157X25000943
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