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Author Topic: osteochondrial desacana  (Read 2276 times)

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Offline herb

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osteochondrial desacana
« on: December 13, 2002, 03:17:15 AM »
I have been diagnosed with this problem in which a section of my femor is not getting adequate blood supply and is dying.  I am told that there is no treatment and that an artheroscopic surgery in which they poke holes in the affected area may help encourgage the blood supply to regenerate bone growth but this has only about a 50% chance of success.  Has anyone else been diagnosed with this problem and what did you do for treatment??
I have had an MRI and the area is about 1.5 cm across but not sure how fast this bone area is dying, and whether there is any other treatment short of a knee replacement.  Any ideas?
Thanks

Offline katie

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Re: osteochondrial desacana
« Reply #1 on: January 07, 2003, 03:53:36 PM »
It's also referred to as "osteochondritis" - the "desacana" or "dessicans" bit is when the dead bone comes off in bits.

Do you know why you have it? - mine was cause post-trauma and the area didn't spread after it had formed. If you have a history of things like high cholesterol or steroid use, you might want to go check with someone who specialises in osteonecrosis/avascular necrosis (ON/AVN)

The recovery rates I've seen publish range from 100% success to 0% success depending on a lor of factors. Age is a big factor - if you're <20, it'll get better. As you get older, the chances get lower. The smaller the area, the better apparently.

I had a similar treatment - removal of the dead bone, fracturing of the underlying core. It was arthroscopic, supposedly day surgery (had I woken up from the anaesthetic properly) and I was partial weight bearing a week later. This is apparently important so that the bone will form the right surface.

The good news here is that 10 months later I'm walking unaided. I have a bit of limp and it's still painful, but it's not "screaming with pain" level, it's a "bit sore".

It's not as radical as TKR, so it's worth a go...
I'm a grouchy software engineer with a sore knee. And I'm bad in the mornings. And I haven't had enough coffee. What was it you wanted doing again?

Offline speeddemon

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Re: osteochondrial desacana
« Reply #2 on: January 19, 2003, 02:48:26 AM »
I suffer with osteochondritis in both ankles.  i have under gone one surger to remove the fragments and level out my bones to premote new growth, but it hurts worse after my surgery than it did be fore, if anyone knows of any other treatment please let me know

Offline herb

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Re: osteochondrial desacana/avascular nectosis
« Reply #3 on: January 19, 2003, 10:09:43 PM »
Katie,
thanks for your reply.
I had the arhtoscopic surgery done on Jan 7th and will be on crutches for 6 weeks as :) I am not to put pressure on the leg (non weight bearing) for 6 weeks so allow full healing.  They took out a large chunk of cartledge ( approx 2 cm by 1.5 cm) which had come off of my knee joint where the bone is dying (femeral chondial?) and this is what was likely causing me so much pain ...as I could sometimes walk fine and then the knee would lock up.
I have little or no pain following two weeks post surgery but living on crutches without being able to put weight on my leg is a big hassle.  Even at the end of 6 weeks he said that I have to be gradual in putting weight on the leg.  I am hopful that the holes he drilled in the femur will encourage growth of the bone and the cartledge (sp?) Do you know if the cartledge can regrow? and what can I do to encourage growth of the cartledge??
Thanks for your earlier reply

Offline katie

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Re: osteochondrial desacana
« Reply #4 on: January 20, 2003, 10:38:13 AM »
Grr. Not fair. My knee was STUNNINGLY painful after surgery. They ended up giving me morphine to stop me yelling, and then I had to spend the night in hospital rather than go home. Yuk.

I got back to weight bearing a week or so after surgery -my os was keen on getting me mobile again although it was with a single crutch for a few months, but I was non-weight-bearing on crutches for ages beforehand while they were working out what was wrong. Actually, this is what caused all the problems, because the muscles in my leg had atrophied a lot before the surgery and it took ages in physio to get them to restrengthen..

The cartilage will, as I understand it, regrow. Although it won't be the same form as before and won't be as tough, but it should be OK as long as you don't overdo things (the harshest exercise I get is walking, and I should be fine. It's a problem if you ski or skydive or things). As for encouraging it, I have no idea. I did take calcium supplements on the basis that it probably wouldn't hurt to make sure I was getting enough...

Living on crutches: get a bum-bag. (Debenhams do one with several pockets on it.) If you turn it round a bit so it's resting on your hip, you can get things like PDAs, mobile phones, purses and so on out without havnig to find somewhere to lean your crutches. (Which is the problem with rucksacks.)

Go buy a proper set of crutches: the NHS ones are crap. 25 quid will get a pair with a cuff height adjustment (which means you can stop your arm getting too bruised) and with sculptured grips (which means they're more comfy).

Avoid shopping centres. Really. People don't leave enough room for your crutches, they make the floors out of (apparently) greased polished glass and you can never get in the lifts for all the people with baby buggies.

The good news is that knees do seem to heal better than ankles with this, and single-site cases heal better than multiple cases. And femoral condyles heal better than other bits of knees. But do be warned it does take a while: I was kind of expecting to be running around after a couple of months -- no one mentioned to be expecting it to be sore for a year or so. The main factor affecting healing seems to be, from reading the literature, age. Anything under 20 has very high healing rates, and it falls off with age.

I'm ~11 months post surgery and it seems to be going well - I still can't wear thin heels because my knee isn't strong enough to balance on them yet, but otherwise I'm fine. So don't fret. Oh, and you might, like myself, end up being able to predict thunderstorms. Oh yes. Autumn-time, I get stabbing pains on the inside of my knee half an hour before the lightening arrives. As superpowers go, it's not very useful.

The only other advice I can offer is take it easy - don't run before you can walk, etc. Oh, and if they offer you the chance to go do hydrotherapy, go for it. It's far more fun than regular physio and doesn't hurt nearly as much. And treat yourself. I saved up while I was hurt and blew about 500 quid on new shoes when I'd healed enough to walk in them... obviously this may not be the way to cheer up EVERYONE, but I'm sure you can think of something to promise yourself..
I'm a grouchy software engineer with a sore knee. And I'm bad in the mornings. And I haven't had enough coffee. What was it you wanted doing again?

Offline The KNEEguru

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Re: osteochondrial desacana
« Reply #5 on: February 23, 2003, 11:06:17 PM »
Just a small footnote - dissecans not dessicans. Just to help you find good links.
KNEEguru
--
KNEEguru

Offline JessToni

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Re: osteochondrial desacana
« Reply #6 on: February 24, 2003, 02:16:30 AM »
Hi,
I had surgery to remove the dead area of bone in my knee.  they did drilling in order to generate blood supply to the area in hope that the area would regenerate itself.  
I had relief for about a year but unfortunately the pain soon returned.  They found that although the area filled itself in, it did so very poorly.  the sruface of the area is extremely irregular and the underneath portion is not so good as well.  which is leading to the reoccuring pain.
i am currently waiting to have another surgery to receive an allograft.  in this surgery they will remove the bad area once again and manually fill it in with fresh bone and cartilage from a cadeavor.  this will ensure a good fit which will hopefully assimilate itself with my existing bone and cartilage.
so while the arthroscopy surgery to remove the piece is a good idea, there is not a 100 percent chance it will be the end all.
let me know if you have anymore questions.

Offline beach

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Re: osteochondrial desacana
« Reply #7 on: March 11, 2003, 09:01:09 PM »
I think I had something similar.
My cartledge protecting my femar has osteoarthritus & is falling apart. My doctor when he reconstructed my ACL found bad cartledge & cleaned it up, then poked holes in it, he explained that the blood fills up the holes. I had to be on a CPC machine (it bends your knee for you) for 8hrs a day for 6wks, non weight baring. Then PT. It worked pretty good it took about 18-24 months before the pain & knee felt good. Probably too good, cuz I injured it again & went thru the same procedure 2 more times. Now the cartledge he said where they did the procedure is good, it is the rest of it that keeps falling apart.

So I guess the main thing is know your limits.
When you feel better doesn't mean you are cured.

Jess, when are you having your cadaver surgury?

:)
1978 ACL tear, 85 menicus tear os fixed, ACL gone. 94 ACL reconstr & chondroplasty, 2000 debrement & chondroplasty, 2003 debrement & chondroplasty.

Offline JessToni

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Re: osteochondrial desacana
« Reply #8 on: March 12, 2003, 12:58:51 AM »
beach,
I wish i knew when i was having the surgery.  everyday i wait for the call that they have got the graft for me.  still no news though. i could be next week it could be in two months.  i am seeing the doc tomorrow though, so maybe he will have an update for me.

Jess















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