Knee osteonecrosis

"If a large portion of the bone surface is affected, or if your pain does not improve with non-surgical treatment, surgery may be recommended".


What is avascular necrosis of the knee?

Knee osteonecrosis, also known as avascular necrosis of the knee, is a painful condition that occurs when the blood supply to a section of bone is cut off.

Osteonecrosis can ultimately lead to the destruction of the knee joint and severe osteoarthritis.

When osteonecrosis is diagnosed early, treatment may involve taking medication to relieve pain or limit the use of the affected knee.

However, for patients with more advanced osteonecrosis, treatment almost always consists of surgery.

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What are the symptoms of osteonecrosis of the knee?

Pain is the most characteristic symptom of osteochondral injuries of the knee. In addition, patients can suffer from joint effusion, blockages, feeling of failure and other non-specific symptoms.

Chondral injuries refer to cartilage injuries (chondrals) or injuries of greater depth of bone and cartilage (osteochondrals) bounded by healthy bone.

This type of lesions and its evolution will depend on many factors such as the affected surface, age of the patient and general situation among others.

Most common symptoms:

  • Knee pain.
  • Inflammation and joint effusion.
  • Blockage.
  • Funcional impotence.

Do you have any of these symptoms?

You may have a problem with osteonecrosis of the knee

How is knee osteonecrosis treated?

Treatment for osteonecrosis depends on several factors, the stage of the disease, the amount of bone affected, and the underlying cause of the disease

In the early stages of osteonecrosis, treatment is non-surgical.

If the affected area of the knee is small, all that is needed is treatment of the pain and inflammation with non-steroidal anti-inflammatory drugs (NSAIDs), steroid infiltrations, platelet growth factors...

Limiting knee activity may help relieve symptoms along with the use of a knee brace and local cooling. In addition, it may be advisable to avoid certain activities that cause painful symptoms.

If a large portion of the bone surface is affected, or if your pain does not improve with non-surgical treatment, surgery may be recommended. 

There are several different procedures depending on the extent of the injury, age, and length of time:

Arthroscopic debridement to help promote blood flow and induce a healing reaction

  • Decompression perforations (microfractures) This procedure consists of creating channels to decompress and encourage new blood vessels to nourish the affected areas of the knee.
  • Osteochondral graft (bone and cartilage). A bone graft is healthy bone tissue that is transplanted to an area of the body where it is needed. The tissue can be taken from a donor (allograft) or from another bone in your body (autograft) using various techniques such as mosaic-pasty.
  • Autologous chondrocyte implantation (ACI). This is a two-stage procedure. In the first stage, your doctor performs an arthroscopic procedure to remove a small amount of cartilage-producing cells (chondrocytes) from your knee.

These chondrocytes are sent to a laboratory where they are cultured (multiplied) for up to 6 weeks to get more cells.

In the second stage, your doctor performs another procedure to implant the chondrocytes in the area of your knee with cartilage loss. The cells then grow in the joint, replacing the damaged cartilage with healthy cartilage.

Osteotomy: In an osteotomy, a change in the bone's load axis is performed. Changing the weight of the damaged side of the joint will help relieve pain and improve function.

Total or unicompartmental (partial) knee prosthesis If the disease has progressed to the point where the bone has already collapsed, you may need surgery to replace the damaged parts of your knee.

For most patients, treatment for osteonecrosis is successful in relieving pain and improving function.

However, results vary depending on the stage of the disease at diagnosis and the type of treatment.

Where do we treat it?


The Department of Orthopedic Surgery and Traumatology
of the Clínica Universidad de Navarra

The Department of Orthopedic Surgery and Traumatology covers the full spectrum of congenital or acquired conditions of the musculoskeletal system including trauma and its aftermath.

Since 1986, the Clinica Universidad de Navarra has had an excellent bank of osteotendinous tissue for bone grafting and offers the best therapeutic alternatives.

Organized in care units

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Why at the Clinica?

  • Experts in arthroscopic surgery.
  • Highly qualified professionals who perform pioneering techniques to solve traumatological injuries.
  • One of the centers with the most experience in bone tumors.

Our team of professionals

Traumatology specialists with experience in the treatment of knee osteonecrosis