KNEE ARTHRITIS - General principles of managing Osteoarthritis of the knee :

Osteonecrosis - long term injections? - - Posted by scarter (scarter), 7 January 2003

I tore my ACL in Jan of 2001, while waiting for repair surgery, I re-injured which completely severed ACL and caused chondyle defect.  Since then the ACL is fine, but the defect has given me continual pain, stiffness, and swelling. My DX is now Osteonecrosis r-femur. My Dr. has sent me for 2 bone scans, one stand up Xray, and 2 MRIs over the course of 2 years.... and gives me regular injections of a combination Lidocaine, Marcaine, and Kenalog. (anesthetic, steroid anti inflammatory).  I get the injections every 3 months, and they seem to work great for the first 2 months and then wear off back to pain, swelling etc...each time gets worse.    My dr has not suggested surgery but has mentioned my options may be : Carticel Autologous Chondrocyte Implant,
OATS - Ostochondral Autograph Transfer,
Osteoarticular Allograft Recontruction.  None of which are a specialty of any Ortho in my area.

Any advice on:

Prolonged injection (steroid) therapy?  
Surgery?
Life with bad knees?

thanks

Posted by lbdeharak (Linda), 14 January 2003

Hi there,

I had the ACI (Carticel) surgery on Nov 6. It is still too soon to tell if it was successful. I can tell you from the research that I did that is is worth traveling to an OS that does this procedure often if this is what you decide to do.

Good luck!
Linda
Posted by violin1 (mj/usa), 14 January 2003

Hi!
The size of your dhondral defect will help determine what kind of surgery you have to fix the defect.  Mine was small enough so that I could go with an o.a.t.s procedure.  That was 4 months ago and I must say that  it has made a HUGE difference!  My knee is almost back to normal.
Should you decide to go for the oats I can certainly give you some input about what to expect, etc. AS for living with the bad knee, well I contemplated that too, and then decided that I would do the operation--I don't regret it.  I also had several injections into the knee beforehand and, like you, I found they lasted a little while and then the knee was a bit worse each time.
It isn't an easy decision to make, try and get as much info as you can, get another opinion (or more) to really understand your options.
Good luckMJ


Posted by scarter (scarter), 14 January 2003

Thanks Linda and MJ:

I have an appointment tomorrow with my Ortho.  I plan to take some time with him to discuss the options.  I did get a tip from another local doctor that I will need to go out of town for this procedure...now I have to deal with the insurance issues.  I'm pretty sure I will opt for the surgery as I still plan to be active for a long time to come and would like a "fresh start".  That and it will only get progressively worse.

::Questions re: the oats surgery...
-How long with no weight bearing post-surgery?
-Is it arthroscopic? (sp?)
-What is the recovery time and how does it compare to ACL replacement surgery?

Thanks again

Sandy
Posted by violin1 (mj/usa), 14 January 2003

Hi Sandy!

About the oats procedure:
I was non weight-bearing for 6 weeks--either in the wheelchair or on crutches. I was also using a cpm machine for 3-4 hours a day for the 6 weeks.
My operation was done partly arthroscopically, partly open. This depends a lot on where the defect is and whether your surgeon can "get" to it through the portals.  Mine was such that my os had to open the knee to place the graft.
Rehab was pretty straight forward; I did a round of pt before the operation, so my quads were in pretty good shape.  After the 6 weeks, I did 3 weeks pt 3x/week.  
I can't compare this to acl surgery; my cruciates were not damaged.
Good luck!
If you are anywhere near the NYC area, I had my surgery done at the Hospital for Special Surgery there, I can highly recommend it.
MJ
Posted by scarter (scarter), 14 January 2003

Thanks MJ, that helps a lot. It is quite different than ACL.  With ACL you weight bear on the 2nd or 3rd day! With crutches and a brace of course.

Sounds like a tougher recovery, but I'm up to the challenge.  My job is sitting down and I can probably work from home if need be.  

Don't think I will be traveling to NYC though, I live in sunny florida.  But I am thinking of getting a referal to the UCF doctors..I hear they are pretty good..if you can get in.

Again, thanks... I'll keep you"posted"

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