Advertisement - Hide this advert





Author Topic: 2nd opinion---osteonecrosis?  (Read 6382 times)

0 Members and 1 Guest are viewing this topic.

Offline kathleenj

  • Forum Faithful
  • ****
  • Posts: 237
  • Liked: 0
  • User's Text
Re: 2nd opinion---osteonecrosis?
« Reply #15 on: May 11, 2005, 06:53:39 PM »
Danielle,

Its very interesting that the osteonecrosis wasnt seen on an MRI, especially if it was causing your bone to be flat.  From what I have read, thats a sign that its pretty severe.  Just goes to show you that MRI's stink :P  actually I shouldnt say that because they do pick up many things, I suppose I should say they are not acurate all the time and leave it at that. 

Anyway, I'm glad your OS was able to see it and do the plugs deep enough to take care of the necrosis.  Necrosis is a little scarey and I'm glad that this new OS of mine is leaning away from it.  Its still a possibility but he doesnt want to jump to such a serious conclusion so quickly.  Hopefully the synvisc will help.  If it does...gosh, I cant even express how happy I will be!!  A little nervous that it wont work and then I will need to proceed with surgery but I am hanging onto hope.  My first shot of the series is Tuesday and tomorrow is my last day of work until Sept so that works out perfectly. 
Wish me luck with it...please...I really need it. 

I hope you have continued success with your rehab.  You seem to be doing awesome!!!
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline kathleenj

  • Forum Faithful
  • ****
  • Posts: 237
  • Liked: 0
  • User's Text
Re: 2nd opinion---osteonecrosis?
« Reply #16 on: May 11, 2005, 07:04:03 PM »
Danielle,

One more thing...about the thermal procedures.  Everything that I read and have heard about them relates to the cartilage.  I'm not sure how it affects the MCL ect..or how using it on the ligaments or anything other than cartilage will affect the underlying bone.   I was looking at info regarding thermal chondroplasty and apparently it can do more damage than good in the long run.  Of course, so much depends on the exact technique used and the setting on the probe.  The more heat, the more it could damage the underlying bone.   
If you do a search for 'thermal chondroplasty' you can find the studies and papers that I was looking at.  I dont have the exact links but they were very easy to find.
Kathy 
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: 2nd opinion---osteonecrosis?
« Reply #17 on: May 11, 2005, 07:27:51 PM »
Kathy,

Good luck with the Synvisc.  With everything else you've been through, it's no big deal.  The synvisc didn't bother me much, but didn't help either.  I wish you better success with it.

On my first MRI in 12/03, there was a thin 1 cm diameter area of ?OCD (ie, necrosis) on the MFC, but my OS said it just looked like arthritis at the time of the scope (1/04) and the bone felt OK with the probe thingy.  I had a repeat MRI in 8/04 and everything looked the same.  But on my scope in 1/05, the cartilage loss was much, much worse.  I didn't have any imaging studies done between August and January, when my OS commented that part of the MFC looked a bit flat.  At the OP, he thought the area was even flatter than it had been in January.  So it really looks like it didn't get bad until very recently.  On the new x-rays today, the MFC looks completely normal, as they were able to reconstruct the original contour.  We just thought this whole time, that the condylar flattening was part of the overall arthritic process, scary.

I was just thinking aloud with the thermal thing.  I'm pretty sure they were far away from articular cartilage.  They used it to fuse my MCL back to the medial meniscus and to seal my medial joint capsule.  Besides, it's been years and years (like 99) since that was done.  I will have to do a lit search, though.

Thanks,
Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline JG

  • Forum Faithful
  • ****
  • Posts: 227
  • Liked: 0
  • User's Text
Re: 2nd opinion---osteonecrosis?
« Reply #18 on: May 12, 2005, 07:12:11 AM »
Hi Kathy,

I'm just getting a chance to reply.  It's nice to have a surgeon who thinks there is hope.  So who is this new surgeon? 

As mentioned before, at my one year mark I had the early diagnosis of necrosis.  I had two options, crutches or an unloader brace for a period of time.  I went for the unloader brace.  I wore it for about 4 months and I still use it during rehab all the time.  It really keeps the pressue off the MFC.   At one point a long time ago, I tried the wedge, but it didn't do much.  As for your swelling, why not prednisone to get it under control.  I'm not sure what a brace will do to control swelling.  Maybe you should look into the brace or ask him about it.  The custom brace is the way to go.

In terms of diagnosis, my surgeon didn't think my medial compartment pain was from the medial compartment but rather the PF.  All he had to do to confirm it was my MC was inject the joint with lidocaine.  Within minutes the pain was gone confirming it was medial compartment not PF.

Well I go in on Wednesday the 18th.  They actually wanted me in today, but I didn't return their call to schedule until Monday afternoon.  I just couldn't pull that off.  They require a pre-op exam by the patient's FP/GP/IM.  I also need to see a hematolgist since I have a clotting problem.   Plus I am incredibly busy at work.  I plan on being awake for at least the knee surgery, but I'm not sure about the nerve surgery since it's nothing I can see and will take a few hours to do.

Keep me posted on your Synvisc shots.  I've not had them even though my surgeon has talked about it.

Keep rehabing!
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: 2nd opinion---osteonecrosis?
« Reply #19 on: May 12, 2005, 12:57:03 PM »
Glad to hear you have everything scheduled, JG.

BTW, if you're worried about necrosis, prednisone should probably be avoided.  All corticosteroids (of which, prednisone is one) can actually cause or contribute to tissue death (bone, muscle, skin, you name it).  It's helpful in a lot of ways, and dangerous in a lot of other ones.

As far as synvisc goes, the shots are no big deal.  But you will be stiff and sore for a few days after them.

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline kathleenj

  • Forum Faithful
  • ****
  • Posts: 237
  • Liked: 0
  • User's Text
Re: 2nd opinion---osteonecrosis?
« Reply #20 on: May 12, 2005, 07:13:54 PM »
Hi Janice,

Glad to hear that you have a date set.  Wow, that really was quick, not much time to make arrangements of any sort huh.  You are brave to stay awake for the knee part.  I was considering it for the last surgery because general makes me really sick afterwards.  I chickened out at the last minute and decided to go ahead with the general.  The anesthesiologist promised to give me enough meds to prevent the sick feeling afterward and things turned out ok.  I would have loved to watch it but for some reason just chickened out.  I was able to stay wide awake for 3 c-sections with no problems but when it came time for the knee I backed out.  Strange.

About my new surgeon...for now I'd like to just call him a knee specialist...staying away from 'orthopeadic surgeon' title since I'm trying to avoid the need for his surgical skills right now.  He is up north in Nh and has run a knee clinic for the past 16 years. Dr O'Neill.  He was recommended to me by a couple of people but I was trying to avoid the 1 1/2 hour drive to see him.  When my husband insisted on another opinion he went looking for recommendations and his named came up a couple of times as well.  As much as I liked Dr Gill...I liked this guy more.  He spent an entire hour with me.  Really took the time to figure out my expectations and limitations.  Nobody ever examined my knee like this guy did.  Nobody ever just sat down and talked to me like this guy did.  I was really sorry that I didnt go to see him sooner because I cant help but wonder if I would still be in this same situation if I did. I still have that appointment set in Sept with Minas but I'm hoping I wont need it. 

My first Synvisc shot is on Tuesday.  As sick as it may be..I'm really looking forward to it.  Keeping my fingers crossed that it will somehow be my little miracle that I've been waiting for.  He mentioned the possibility of trying an unloader brace but we decided to try the wedges first to see if they help at all.  If I have significant improvement with them then we will go that route.  For now, I'm being fitted for the custom wedges tomorrow. 

As for the swelling issues...its not constant for me.  When I get up in the morning the knee is ok. As the day goes on and depending on my level of activity it will begin to swell.  By the time its evening the knee is pretty swelled up.  He wants me to wear a brace for the compression.  I suppose technically its not a brace per se...more of a sleeve but it is also hinged for support.  He said the compression will keep the swelling out of the knee.  I'm not really sure about that as yesterday I wore it all day and then about an hour after I took it off the knee started to swell.  Who knows, but I'll try anything right now.  I've also decided to change the time of day that I do my rehab.  I normally do it in the evening after the kids are put to bed but it seems that by that time the knee is pretty much shot.  duh!  So I decided that since I'm not working for the rest of the summer I would try to do my rehab in the morning when the knee is the least irritated.  Makes alot more sense to me and wonder why it took me so long to figure that one out...feel like smacking myself in the head for that one.  Anyway, we will see how that goes. 

Please keep me posted on your surgery next week.  I'll let you know how the synvics shot goes for me. 

Take care
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja















support