Sponk ppt
- 1. SPONTANEOUS OSTEONECROSIS OF THE KNEE (SPONK) (SONK) DR. LOKESH SHAROFF ORTHOPAEDIC SURGEON, MUMBAI, INDIA
- 2. DISCOVERY Spontaneous osteonecrosis of knee (SPONK) was first described by Ahlback et al in 1968
- 3. CLASSIFICATION OF OSTEONECROSIS OF KNEE SPONK – Seen in older patients Secondary Osteonecrosis – Post sickle cell anemia, corticosteroid treatment, etc Post – arthroscopic menisectomy
- 4. SPONK Women more affected than Men Mono-articular usually Vascular interruption theory akin to AVN 55 years or older
- 5. VASCULAR THEORY Cadaveric study by Reddy and Fredericks demonstrated that the medial femoral condyle has limited intraosseous blood supply with definite and apparent watershed areas Hence, medial femoral condyle is involved in 90% of the cases
- 6. NATURAL COURSE OF UNTREATED SPONK Lotke et al described that the SYMPTOMS of SPONK can last even upto 7 years after the diagnosis of SPONK has been made. Patients presents with sudden onset pain – just as in a case of a medial meniscal tear ( Pain occurring over the inner side of knee joint)
- 7. Diagnosis XRAYS – can show a radiolucent articular surface area with squaring of the medial femoral condyle. MRI – is gold standard in making the diagnosis. T2 – images – shows bone oedema T1 images – shows Articular surface involvement.
- 8. TREATMENT Conservative vs Surgical methods
- 9. CONSERVATIVE MANAGEMENT Protected weight bearing. Non-steroidal anti-inflammatory medications (NSAIDS), Bisphosphonates, Prostaglandins.
- 10. CONSERVATIVE MANAGEMENT Bisphosphonates like zoledronic acid has shown promise in literature
- 11. SURGICAL MANAGEMENT Core decompression by drilling, Bone grafting, Osteochondral grafting, Arthroscopy, Tibial osteotomy – to align the knee in case of deformities Unicompartmental arthroplasty Total knee arthroplasty
- 12. TOTAL KNEE ARTHROPLASTY INDICATIONS: Arthritis sets in, Large area of articular involvement, Deformities – varus or valgus with SPONK
- 13. NOTE SPONK is a curable condition if detected early !!!! THANK YOU