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Core decompression knee avn (osteonecrosis)

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C0bbie

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I've had core decompression on my left knee for avn found on the MRI scan. I think i have stage 3 osteonecrosis. Im looking fir guidance on recovery. Its been a week since surgery now, no weightbearing for 6 weeks, its horrendously frustrating and i have no pain. I need to know about recovery, physio etc. it's in a brace, is this operation really that major, wheelchair for 6 weeks? When can I start physio? I just can't find anything or anyone who had this op to give me some help? Im a scuba diver and desperate to get back in the water asap. Hope you can please?
 

Josephine

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Hey, you made it! Welcome to BoneSmart!

It's more common to have members with core decompressions in the hip so this is a first for us! However, the principles are the same.

AVN is a process where the bone is dying due to failure of the blood supply. Part of that process is that the bone becomes very frail and soft and begins to collapse. The intention in doing this procedure is to try and stimulate blood supply and bone growth to the area. This can be done a number of ways but all are based upon drilling holes in the bone and inserting either bone or trabecular implants which are very similar to bone. Both these will hopefully cause the regrowth but it takes quite a while.

aflagsforworship.co.uk_jo_pic_images_tantalumro.gif


In the meantime, the bone that was already fragile and painful, has been rendered even more fragile by having holes drilled in it. In order for no more collapse to occur, non-weight bearing it essential for some weeks. In normal fractures we know that bone healing will take between 6 and 12 weeks. It's likely that after your 6 weeks NWB, you will be required to be partially weight bearing for a further period.

As for physio, that really is the surgeon's call but did they not give you some exercises to be going on with that won't involve weight bearing? I suggest you phone the surgeon's secretary and check out if you should have been given instructions. You need to know this, so do it tomorrow morning.

You are very lucky not to have any pain. But right now you just need to remember your bone is in a delicate condition and needs to be babied a lot!

Incidentally, at which hospital did you have this done? And which surgeon did it? I am intrigued.
 
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C0bbie

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Eventually yes, thanks for your persistence!

It's been soooo difficult finding info on this and I have to say I'm so depressed over it all as I'm totally confused.


You say they normally put either bone or trabecular implants in the drilled hole, but I've been told he's just drilled holes in it to get new bone to hopefully generate. How long does bone take to regrow?
The op was done at the Birmingham priory hospital by dr Marcus green. I initially had an MRI in may 2011 which showed nothing up but my pain got progressively worse over the next 10 months and I'd had 5 steroid injections when I insisted on another MRI as I knew something was wrong. This is when the avn showed very evidently on the MRI in April 2012. Mr green was very surprised at how aggressively it had developed in such a relitavely short space of time! He bought me straight in for surgery last Friday, (9 days ago)


I want to get in the sea ASAP but can't seem to get anyone to give me any firms guidance as it seems not many people know much on the knee as you say its mostly hips! I'm wondering if I'll need a new knee eventually, can avn "heal" or go away or if I have it, is that it, are other joints now susceptible.


I really, really appreciate your time nd advice Josephine, thank you! If anyone else has experience, please get in touch.


Leigh
 
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C0bbie

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Just another quick question, sorry! Does taking arnicaAnd collagen supplements help speed up recovery?
 
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IMHO, if these supplements had been tested and shown to promote healing, doctors would be prescribing them for patients. So I doubt that they will do anything for you.
 

Jamie

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There is nothing you can do to speed up healing. Your body will repair itself on it's time schedule and being patient with this process is important for you. If this procedure is to work at all for you, you MUST follow your doctor's instructions about activity to the letter. I hope Jo's explanation of the weakened condition of your bones right now was clear enough to help you understand why you are not weight bearing.

Please try to keep in mind that right now, your healing is infinitely more important than scuba diving. You'll be back doing what you want in time, but right now your priority is babying that knee and healing.
 

Josephine

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It's been soooo difficult finding info on this and I have to say I'm so depressed over it all as I'm totally confused.
Well, I already said, this is an old, old procedure and we did many when I was a fledgling theatre nurse back in the 60s, 70s and 80s. So it's quite likely I may be your only source of information! :wink1:
You say they normally put either bone or trabecular implants in the drilled hole, but I've been told he's just drilled holes in it to get new bone to hopefully generate.
Ah, well that's the old, old procedure I mentioned. It's actually not a Core Decompression at all, just a drilling of the femoral or tibial condyles. That was the original treatment, to drill holes that filled with blood rich with bone cells which, hopefully, would then become an immature kind of bone. Did it work? I have no idea as I wasn't really into things in that depth in those days. All I know is the surgeons would speak of it as a "Well, we might as well try this" kind of attitude which wasn't very encouraging. But then, we didn't have any other options in those days!
How long does bone take to regrow?
I think I said this in my previous post, didn't I?
"In normal fractures we know that bone healing will take between 6 and 12 weeks."
I want to get in the sea ASAP but can't seem to get anyone to give me any firms guidance as it seems not many people know much on the knee as you say its mostly hips!
Absolutely not! You cannot do anything like that until Mr Green gives you permission which will likely be about 8-10 weeks at the earliest. You don't want to have had this surgery only to muck it all up, do you? The sea will still be there in 2-3 months time and all the sweeter for the wait!
The op was done at the Birmingham priory hospital by Mr Marcus Green.
I had a peek at his bio - he looks okay but I am wondering why he would be doing such an old fashioned treatment on you. :scratch: However, he did qualify in 1986 so he could be in his fifties.
I'm wondering if I'll need a new knee eventually, can AVN "heal" or go away or if I have it, is that it, are other joints now susceptible.
Well, that is a distinct possibility because if the drilling doesn't work, then arthritis will have been enabled by the damage done in the drilling.

Should this come to pass, you do not want to listen to people (and surgeons) who say you are too young to have a knee replacement. We've had 20 year olds on this forum had knee replacements. It's your quality of life that counts, not your age.
I really, really appreciate your time and advice Josephine, thank you!
You're more than welcome though I know I have given you some bad news in there. But overall, it's what we are here for!
 
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C0bbie

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Hi all, I can't thankyou enough for your input, your all soooo right! Patience isn't my forte but I have no choice really! I'm desperate to dive, but as you say, it's always going to be there Isn't it! The more I think about it, given my lifestyle, he should have just replaced it.

I'm extremely active so at stage 3 AVN, CD looks to be more experimental than solution! He didn't want to wait 2 months as I asked him in case it collapsed which would signal to me it was quite far on! If this doesn't work, I'm not messing about, I'll just insist on a replacement or change surgeon!

Thank you all, particularly Jo, you've been more help than you can imagine! Thank you! Leigh
 

Josephine

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Another point - any collapse would likely be gradual rather than catastrophic. And a person can still get around on a collapsed bone! I see people in the street almost every day with knocked knees or bowed legs, depending upon which side has collapsed! The varus version (incorrectly spelled vargus in the image) is the most common.
aflagsforworship.co.uk_jo_pic_images_valgusvaru.jpg


See this chap, one of our past members, had really bad knees but still managed to go sailing in his yacht! Here he's had the left knee done, the right was soon to be done and now his legs are straight as dies!

aflagsforworship.co.uk_jo_pic_images_varusdefor.jpg
 

vicm

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I had core decompression on my right knee five weeks ago, and yes it is extremely hard work to stay off that foot! especially with three kids! It has just now, got easier for me as I have been doing exercises for 5 mins. every hour, as shown to me by a physio. (whom I visit every two weeks) they include raising leg, bringing leg up to chest whilst on a bed, and generally keeping the joints moving, and building up the quads. NO WEIGHT BEARING AT ALL! I have had a couple of stumbles, and the sensation going up my foot has been like electric shock/ severe pins and needles, I recommend a walker,(Not wheeled) for around the house. I have had very little pain, just odd tingles and pain after a bit of physio. I have an x ray at six weeks, to see if the bone has started healing, then the consultant reckons 4/6 weeks rehab.after that for
walking; gradually weight bearing 25%, 50% and so on. It is a long haul I'm afraid, and I didn't realise how long! There is no info re rehab.at all. so I shall post info as it happens!
 
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C0bbie

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Hi Vicm, how good to hear someone else who's in my boat, I'm tired of hearing, wow this is a first, even my 1st physio visit last week! There's nothing on the Internet anywhere either is there? Josephine was great and picked me up as I've been very low, I'm so active and independent this is killing me! So your 5 weeks, I'm 3 now so I hope you don't mind me picking your brains? I'm in a wheelchair and crutches when the chair can't get there, I too have had a few stumbles, and totally agree, it's more from the foot than knee the pain occurs. I feel for you big time, 3 kids, how do you do it??? I've started my excersises Thursday, ok..ish, I can bend it 90 degrees if I'm sitting on a chair, but on the bed, I get to just before 45 degrees and oh my god, excruciating pain that just shouts NO MORE, is that normal? Did you have CD due to osteonecrosis? In a bad way I feel good knowing there's someone else out there with experience!!! Leigh
 
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C0bbie

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Josephine, you said CD was an old, old procedure, do you know what's the latest alternative to CD please? I'm just inquisitive as to why this was done and what was an alternative.

@Josephine:
 
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C0bbie

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from cobbie to Vicm
HI vic, nope, im a 39 yr old girlie, but not very girlie really! so your just up the road from me, im in wythall near solihull. Marcus green is my surgeon and he sounds similar to yours, isnt really too experienced in this! i think thats why we find ourselves on these websites as we both feel a little in the dark. i too dont hold out much hope, somethings telling me this hasnt worked but i seem to be EXACTLY the same as you Vic. i can bend mine at 90 on a chair, but sliding foot lifts with me supporting the knee is not even 45 degrees without a point that hits excruciating pain like ive never felt before. i fell over last night and i didnt have my leg brace on and i was literally sick with the pain. i cried my heart out as i live alone! then had to clear that mess up on one bloody leg! i too am scared stiff as what you write is like your explaining me all over Vic. my surgeon hasnt said about an xray but i think im going to insist on one, i asked last week at a check up how we would know if it had worked, he said i wouldnt be in anymore pain like i was before the op...but i want more than that, i want to SEE its worked. i had to insist on another MRI as the one in May 2011 was totally clear although i had pain, 10 months later and im at stage 3 like you. so it sounds like you have SPONK which is simply just spontaneous osteonecrosis without explanation? although i am a diver, im such a careful one and i dont think my diving is the cause. lets keep in touch, im on +++++ if you feel like a chat, my family dont understand my frustration etc. i think we should also post our reviews just in case someone else is in our shoes so we can maybe help calm them down as youve certainly done that for me Vic....xxx
 

Josephine

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Josephine, you said CD was an old, old procedure, do you know what's the latest alternative to CD please? I'm just inquisitive as to why this was done and what was an alternative.
I meant it's been done for decades. But it does work in knees, I believe, much more so than in hips.
 
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C0bbie

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agh ok, got you. ive found a lady Vic, whos had exactly the same and were communicating here and keeping each others spirtits up, she helping me more i guess as shes 2 weeks ahead of me. this forum is excellent for settling the mind....
 
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C0bbie

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Originally Posted by C0bbie
hahahah, i get that all the time, when people call me and hear a female, i can see their faces through the phone! its lovely emailing you as you are sooo me typing that, everything you say im like, omg yes. i have a black material brace with metal rods in it that i can take my leg out of for my exercises. i cant imagine not having it on actually as its so painful to let it just hang. i agree, my wheelchair is my lifeline, the crutches are awful, particularly as i had a shoulder operation in october that i havent recovered from yet!!! left side again! how young are you Vic? yeah, live alone, got sister who comes round everyday and mates have been great company. i can do quite a lot with my wheelchair to be honest. i too TOTALLY agree, nobody understands and i didnt realise the recovery time and restrictions that no weight bearing was like. please keep in touch, your emails cheer me up! my partner is working in costa rica at the moment so he gets the brunt of my frustration daily but youve made me see i need to be patient!xx


Hi Leigh,
Hope your knee is holding up! I have had an x ray and it has worked! The bone has started to grow, and the holes have filled in! So 6 weeks is the goal! I can now put weight on my right foot (no pins and needles, when done gently either!) and I am getting around quite well, with crutches and the walker. The knee goes purple when I've been standing on it for a while, but once iced, and elevated for 30 mins; off I go again! This should ease as I walk more apparently. My knee bend is not brill but a different PT massaged it, using a basic moisturiser, before doing sliding pull ups, and what a difference! Consultant reckons I will be driving in 2 weeks! He is obviously brilliant in my mind now! He also said the feeling of throbbing/bubbling in my blood was the venous system (or something, I wasn't listening, as I was in shock) and all these odd feelings should subside with increased mobility; so watch this space! I have to say I am amazed how I can put my foot down with out too much pain, if any! But my other knee is deciding to hurt now! S'pose it's had enough of the weight bearing!
So there is light....
Hope you are doing ok and don't push it! It was in week 5 that I felt 'lighter' about it, but yesterday I was worried sick it hadn't worked, so here I am!
More updates later.
Take care,
vicx
 
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