How is Avascular Necrosis Diagnosed?
Osteonecrosis of the knee may take several months to over a year for the disease to progress. It is important to diagnose this disease early, because immediate treatment has shown better patient outcomes. Dr. Mazzara will obtain a medical history and ask about patient symptoms. He will then perform a thorough examination of the knee and look for symptoms specific to AVN. In the early stages of the disease, symptoms may be quite intense and, because routine x-rays are normal, a positive bone scan or MRI may be requested to confirm the diagnosis.
How is Osteonecrosis of the Knee Treated?
The initial treatment for osteonecrosis of the knee is non-surgical, focusing on pain relief and reducing the stress placed on the injured bone. Non-surgical treatment may include:
- Knee Brace: Designed to take pressure off the involved joint surface can aid in healing.
- Crutches: Reduced weight bearing on the affected joint can slow bone damage and help with healing.
- Medications: Anti-inflammatory medications may reduce pain and swelling.
- Exercise: Physical therapy designed to strengthen thigh muscles and reduce stress on the knee joint can be beneficial in bone healing. Often, water exercise is recommended to keep avoid stress on the knee joint.
How to Treat Osteonecrosis with Surgery
If non-surgical treatments fail to alleviate symptoms and associated bone death, surgery may become necessary. Surgical intervention for osteonecrosis of the knee is based on several factors including patient age, extent of damage to the joint and the area of necrosis. For patients in Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford communities it is important to see Dr. Mazzara, who has extensive experience in treating knee osteonecrosis. Some of the surgical treatments Dr. Mazzara may use are:
- Arthroscopic Debridement and Microfracture: Arthroscopic surgery uses a small camera and small instruments to perform surgery inside the joint. Debridement is when Dr. Mazzara removes loose bits of bone or damaged cartilage from inside the joint space. Microfracture is when small holes are made inside the bone to promote blood flow which can heal the lesion.
- Bone Grafts: Using healthy bone to replace damaged bone. Presently, the bone grafting is a minimally invasive arthroscopic procedure where calcium phosphate can be injected into the avascular segment of the bone encouraging the healing process.
- Osteotomy: A procedure that involves cutting the bone and changing the realignment to relieve stress on the bone or joint.
- Partial joint replacement: This is reserved for knees where the cartilage is otherwise normal and the knee is well aligned but there is a compartment of the knee where the osteonecrosis has resulted in bone and cartilage dame that cannot be treated by other means.
- Total Joint Replacement: In this procedure the entire knee is replaced. All compartments of the knee are actually resurfaced usually because, in addition to the osteonecrosis, the other parts of the knee are also arthritic.
- Arthroscopic decompression: This is a minimally invasive procedure where the infarcted of avascular segment of the bone is drilled to reduce bone pressures and encourage the healing of the bone by creating new channels into which new circulation will enter, encouraging the body to heal itself. It is a way to jump start the body’s own healing response. Presently, we would also inject calcium phosphate into the bone making it stronger as well. This injection of calcium phosphate is called a “subchondroplasty”.
Patients who have osteonecrosis of the knee are urged to seek medical care early. If you have questions about knee osteonecrosis and the correct treatment for you, please contact the orthopedic offices of Dr. James Mazzara, knee specialist in Manchester, South Windsor, Rocky Hill, Glastonbury and surrounding Hartford communities.