Avascular Necrosis of the Knee

Patient

Q: I developed pain in my right knee roughly 5-6 months ago. Two months ago after reviewing the x-ray, I was diagnosed with Avascular Necrosis in my knee. The Orthopedic seemed a bit surprised at the location of the injury, small collapse on inner portion of femur near knee joint (yet not in the joint itself), and asked if I experienced trauma to my knee recently. I explained that the pain just popped up without injury and that baffled him a bit more. Long story short, I was instructed to wait a month and go back for an exam. No instructions to limit activity or anything (even though I did stop certain activities); after a month there was no change. During the next visit he opted to prescribe alendronate to help the bone heal itself and to report back in a month. Again there has been no progress and I've been told to try alendronate again for another month. I've been dealing with this injury for half a year now and I seem to be just spinning my wheels. I'm set to see a different Orthopedic in a couple of weeks and am curious what your thoughts are on the process so far and what to expect. Not asking you to criticize another doctors work, just another opinion of sorts.

Doctor

A:   Avascular necrosis can be painful and devastating condition which may even affect more than one bone at a time. There are several theories as to cause of the disease including an association with alcoholism, steroid use, post trauma and as a side effect of some medications. Treatment for the condition varies according to the location of the disease, age of the patient, severity of the disease and the general health of the patient. Given your age and the location of your disease most orthopedic surgeons would recommend conservative therapy with medications like Alendronate. Given that this treatment has been unsuccessful then more invasive therapy may be in order. There are several surgical procedures that may be considered in attempt to relieve your symptoms. It is important that you aware that no single treatment has been found that offers a cure for the condition. Your new orthopedic surgeon may suggest core decompression which involves drilling a hole in the bone to relieve the pressure and thus reduce pain. This surgery is particularly effective in the early stages of the disease.He/she may also suggest a bone graft to promote new bone growth. Best of luck

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