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Author Topic: avascular necrosis osteonecrosis  (Read 8880 times)

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Offline sumlvr

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avascular necrosis osteonecrosis
« on: September 03, 2010, 01:23:24 AM »
I had an MRI of my Left knee, it shows multiple bone infarcts in the distal femur and proximal tibia the largest infarct is seen in the posterior medical femoral condyle. I am in much pain. I was told by an orthopedic dr that since my joint has not collapsed there is nothing that can be done. There is also significant amount of reactibe bone marrow edema involving the medical femoral condlye. Also abnormal bone marrow signal involving both medical and lateral tibia plateau. Small amount of Joing fluid. I am at lost. Has anyone heard of waiting till the joint collapses? Any input on this will be greatly appreciated as I do have much pain especially on the medial side of knee. Is there a difference between osteonecrosis and avascular necrosis? Please Help. I dont know what to do next. Thank You. My email address is [email protected] My name is Lisa.

Offline oreo

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Re: avascular necrosis osteonecrosis
« Reply #1 on: September 18, 2010, 05:05:27 AM »
I'm 2.5 months out of meniscus surgery... had another MRI done this week due to severe pain and it shows the same. AVN - medial and lateral femur, also the bone marrow swelling and fluid - plus I have fragments that are loose.  My doc want to do surgery. Basically he said he would clean up (smooth) all the dead bone.  When he does this I will lose a good portion of cartilage. For this he will do a "MicroFracture Procedure" in which he will drill small holes in the bone (in hopes) the cartilage will grow back.  Recovery and very long - no weight bearing for minimum of 8 weeks.

I'm getting 2 other opinions next week - so I can fill you in later on what those doctors state.

Research "AVN" and "Osteonecrosis" online and they will give you treatment options.  I would personally like to try the steriod injections. This should reduce the inflammation which in turn should reduce some pain.  The other option I read about it using an "Unloader brace".   I've heard this can also rid you of pain and prolong surgery... however you must wear it all the time when weight-bearing.  I however, am NOT a candiadate for the brace since both medial and lateral sides of my femur are necrotic.

My PT guy told me it's alright to ride a bike and swim... no squats, leg presses and no stairs if possible.  If you are doing something that causes you pain... stop (if you can).  I've been living with pain for 3 months now...  doc says it's up to me on when to do the surgery - that the pain will eventually get worse, ROM will become restricted - then I will know it's "my time" for surgery.... or he can do it next week if I want.  I just told him to "let me think about it".

Good luck.  I know the pain is annoying - oddly night time laying down is even painful (for me).  Please keep posting on how things are going.  Get a second opinion... or 3rd. 

Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #2 on: September 18, 2010, 05:52:39 PM »
Hi Oreo,
Thank you so much for your response. I have had another opinion also from an ER doctor that says if I just wait my leg will have to be amputated and I did mention it to the last ortho I saw and he said that is not true. I am so glad that you wrote. Please keep me updated as to your condition, as I really need advice. I have tried the steroid injections, and they do not help at all. Once again Thanks for writing and Hope to hear from you soon.

Lisa

Offline oreo

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Re: avascular necrosis osteonecrosis
« Reply #3 on: September 19, 2010, 01:05:01 AM »
I've never heard or read about a leg amputation for AVN... but I'm not a doctor.  If your need so REALLY REALLY BAD then I would assume that a TKR (Total Knee Replacement) would be the final option. 

AVN is not a disease like cancer in which it can spread.  You bone dies because the blood supply going to that bone has been cut off.  It's cut off either by a blood clot or from the swelling in the bone marrow causing the blood vessels to constrict - thereby severely decreasing the flow of blood to the bone.  If you know you have bone marrow swelling and fluid, then this must be treated first in order to hopefully prevent damage to the bone.  If you are prone to blood clots, you may be prescribed a blood thinner or even something a little as an aspirin.  The steriod injection into the knee should reduce the inflammation.  This in itself should reduce your pain and reduce the inflammation.  Which is what we want until we can figure out surgical options. :)
Again... I am NOT a doctor.  I'm just telling you what I've been told or have read.  I hope to have 2 more doctor's opinions next week. I will keep you posted for sure.

Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #4 on: September 19, 2010, 02:37:35 AM »
Thanks Oreo, please keep me posted!!

Lisa

Offline oreo

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Re: avascular necrosis osteonecrosis
« Reply #5 on: September 22, 2010, 08:32:45 PM »
So I had my appointment this morning with 2nd opinion doctor.  Basically he saw the MRI report and scan and said he won't take me on as a patient nor will anyone in his firm.   He said he would have performed a "decompression surgery" had this disease been caught sooner.  The rest of the meeting was him taking offense to me "shopping around for opinions from doctors" and not trusting my original OS, scolding me like a little child. 

Recap:  3 months ago my MRI scan showed nothing. Then 1 week ago a new MRI scan shows AVN with a loose, but not detached fragment, along with marrow edema.   I was visiting my OS weekly as well as PT... doctor #2 made it seem like "I let" this happen.  He was a jerk.  I wonder if my original OS did something that caused this. ??   He knew I have been in pain, and getting worse each week I saw him.  He, as a doctor, chose to do nothing... until I DEMANDED another MRI (from a different facility).  I don't think anyone should fault me, knowing my story, with OS, for wanting a NEW OS.

I will let you know Friday how 3rd Opinion Doctor responds. 

I'm trying to keep my humor about all this, however, it's difficult.  How is your pain? Have you heard anything else? 


Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #6 on: September 22, 2010, 09:49:59 PM »
Hi Oreo,
Sorry to hear about your bad dr's visit. That is really to bad. I have come across a few actullay the last 2 os who thought there---- did not stink. It is really irritating. No I have nothing more to report, as the last one told me no surgery till the joing collapses. I do have pain, I do not know if you take anything but right now for the past month I have been on Oxy 40 mg LA every 12 hours and also Norco for break thru pain.
I am going to see my regular Dr. 2morrow. I hope she will help me out with getting Disability something I have been fighting for for over a year now. I also suffer from chronic depression and have herniated discs in my neck as well. I have been turned down twice, I now have a lawyer and really hope I get it. Anyhow, hope your next Dr. visit goes well. I am sick and tired of being sick and tired as I am sure you are also!

Lets Hang in there, and thank you so much for writing me you are the only one who responded to my post and I sure am thankful for it.

Lisa

Offline oreo

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Re: avascular necrosis osteonecrosis
« Reply #7 on: September 22, 2010, 11:34:43 PM »
Lisa,

Does your pain come and go or is it always constant and always in the same spots of your knee?  Does the pain change with activities, such as walking up and/or down stairs?  Do you still have pain if you are relaxed laying in bed or a recliner?

I read today that the marrow edema is what brings on the pain in AVN and makes it come and go.  I will try to find where I read that and send you the link....  I thought it was interesting because my pain does come and go. It's never "all the time".  Night time for me seems to be worse - as if my knee has just had enough come the end of the day and it's mad at me.   :) 

I was just wondering.... 

Kimberly

Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #8 on: September 23, 2010, 01:09:44 AM »
Hi Kimberly,
One of the classic signs of AN is having pain when you lay down to go to sleep. Yes my pain comes and goes. It is really bad walking up stairs,
or if I have to stoop down. Let me know your story I would be interested to hear it, thank you so much for writing and I look very forward to hearing from you!!!

Your kneegeek friend,

Lisa

Offline oreo

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Re: avascular necrosis osteonecrosis
« Reply #9 on: September 23, 2010, 02:32:18 AM »
Hey Lisa ~  I sent you an email with the link.   :)

Kimberly

Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #10 on: December 08, 2010, 10:06:51 AM »
Hi, I hope this is Kimberly, I have not heard from you in awhile. Not much knew the AVn has spread to my ankle now. like I said before, i have had so many different opinions, but I just feel lost. Any news with you? I know that your were moving please keep me adivsed my email is
[email protected] Hoping to hear how you are.
Lisa

Offline sumlvr

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Re: avascular necrosis osteonecrosis
« Reply #11 on: January 19, 2011, 06:10:38 AM »
Hi Kimberly,
This is Lisa (Sumlvr) we chatted in September, I never heard back from you as to how you are doing. Any new things with your avn, all I can tell you about mine is it is getting worse. As a matter of fact having a horrible night. Waking up every 2 hours with extreme pain, any new surgeries for you? I am just wondering, no one but you has posted to my post. Last I heard I think you were moving to or in Ill. which is where I am. Please let me know how you are. Thank You.















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