Osteoarthritis with osteonecrosis
April 5, 2011 | 20,00 EUR | answered by Christian Klein
Hello,
I have received an MRI report. Retro-patellar arthritis with a small osteonecrosis on the femur. Six months ago I had a bone marrow edema... the osteonecrosis and arthritis seem to have developed from that. My question is, can a shockwave therapy (high-energy) heal the bone injury (osteonecrosis) and therefore prevent the arthritis from worsening? What other options do I have to become physically active again?
I live in the Leipzig area, which doctor in the area can be recommended for this?
I am only 26 years old and weigh 85 kg.
Thank you.
Good day,
As you tell the story, you have 2 pathological findings in your knee. Firstly, cartilage damage/arthritis on the kneecap, which unfortunately cannot be reversed. Here, further progression can be slowed down with, for example, weight loss, specific muscle strengthening, etc. However, sometimes the MRI findings are a bit exaggerated, so some wear and tear on the kneecap is not too bad.
Secondly, there was a small bone marrow edema (stage 1 of osteonecrosis), which may have worsened to osteonecrosis stage 2 or 3, depending on the MRI findings. The question is whether there has been any worsening?
In general, these osteonecroses rarely heal completely in adolescence, but can develop over months to stage 4, i.e. a defect in the cartilage down to the bone.
There are therapy recommendations for each stage, ranging from medications such as bisphosphonates, calcitonin to short-term partial weight bearing, weight reduction, quitting smoking(!), to treatments with ultrasound/shock wave or magnetic field. Unfortunately, it is not certain whether these measures help, but they rarely cause harm, and those who can afford these measures financially can try them. They all share the idea of stimulating bone metabolism or stopping breakdown.
If your knee hurts and swells with stress, leading to fluid buildup in the knee, I recommend considering arthroscopy, in which, depending on the size and stage of the osteonecrosis, drilling, refixation with pins or screws, or even cartilage/bone cylinder transplantation from another site in the knee may be necessary.
Since colleagues in smaller practices often cannot or do not want to perform the latter measures and tend to recommend the "more expensive" alternatives, I recommend presenting yourself at a sports or knee clinic in a larger hospital such as the university hospital in Leipzig, where the entire spectrum, especially surgical, is mastered.
I hope I could help you, as a tip, next time you could maybe attach the MRI findings.
Regards,
Dr. Ch. Klein
