Osteonecrosis of the Knee

[Guest guest]

Poor Baby.I’m sorry. It must be so painful. Cheryl in CA

From: Deanna

Sent: Sunday, February 22, 2004

9:45 AM

To: Lupies

Subject: Osteonecrosis of

the Knee

Osteonecrosis of the Knee

Knee pain has many causes. A relatively common cause

of knee pain in older women occurs when a segment of bone loses its blood supply

and begins to die. This condition is called osteonecrosis, which literally

means " bone death. "

In the

knee, the knobby portion of the thighbone on the inside of the knee (the

medial femoral condyle) is most often affected. However, osteonecrosis of the

knee may also occur on the outside of the knee (the lateral femoral condyle)

or on the flat top of the lower leg bone (tibial plateau).

Causes

The

exact cause of the disease is not yet known. One theory is that a stress

fracture, combined with a specific activity or trauma, results in an altered

blood supply to the bone. Another theory supposes that a build-up of fluid

within the bone puts pressure on blood vessels and diminishes circulation.

More than 3 times as many women as men are affected; most are over 60 years

of age.

Osteonecrosis

of the knee is also associated with certain conditions and treatments, such

as obesity, sickle cell anemia, lupus, kidney transplants, and steroid

therapy. Steroid-induced osteonecrosis frequently affects multiple joints and

is usually seen in young patients. Regardless of the cause, if the disease is

not identified and treated early, it can develop into severe osteoarthritis.

Signs and symptoms

Sudden pain on the inside of the knee, perhaps

triggered by a specific activity or minor injury

Increased pain at night and with activity

Swelling over the front and inside of the knee

Heightened sensitivity to touch in the area

Limited motion due to pain

Development

Osteonecrosis

of the knee develops through four stages, which can be identified by symptoms

and X-rays.

Stage

I: Symptoms are most intense in the earliest stage. Symptoms may continue for

6 to 8 weeks and then subside. Because X-rays are normal, a positive bone

scan is needed to make the diagnosis. Treatment at this point is nonoperative

and conservative, focusing on pain relief and protected weight-bearing.

Stage

II: It may take several months for the disease to progress to Stage II. At

this point, X-rays will show that the rounded edge of the thighbone is

starting to flatten out. An MRI or bone scan can be used to diagnose the

disease. A CT

scan may also be used to measure the affected area of bone area.

Stage

III: By the time the disease reaches stage III (3 to 6 months after onset),

it is clearly visible on X-rays and no other diagnostic tests are needed. The

articular cartilage covering the bone begins to loosen as the bone itself

begins to die. Operative treatments may be considered at this point.

Stage

IV: At this point, the bone begins to collapse. The articular cartilage is

destroyed, the joint space narrows, and bone spurs may form. Severe

osteoarthritis results and joint replacement surgery may be necessary.

Treatment options

In the

early stages of the disease, treatment is nonoperative. If the affected area

is small, this treatment may be all that is needed. Options include:

Medications to reduce the pain

A brace to relieve pressure on the joint

surface

A conditioning program with exercises to

increase the strengthen of the muscles in your thighs

Activity modifications to reduce knee pain

If more

than half of the bone surface is affected, you may need surgical treatment.

Several different procedures may be used to treat osteonecrosis of the knee.

Among the surgical options are:

Arthroscopic cleansing (debridement) of the

joint

Drilling to reduce pressure on the bone surface

Procedures to shift weight-bearing away from

the affected area

Replacement of one or both joint surfaces

Your

orthopaedic surgeon will discuss the options with you and make a

recommendation based on your individual situation.

Much Love,

Deanna

LUPUS Serenity Prayer...

Lord, grant me the

serenity to accept the things I cannot change, the courage to change the things

I can, and the wisdom to hide the bodies of doctors I shot when they said,

You're perfectly healthy, it's all in your head "

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