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avascular necrosis
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badguy1952 posted:
Hi, has anyone out there had AVN of the femur at the knee? I do, and the option I have been given is complete knee replacement. I am 57, younger than most knee replacements, but my doctor believes that going forward without the surgery will eventually lead to complete collapse of the femur in a fairly short time frame. Has anyone else had AVN of this joint? How did it go? Have you been diagnosed with AVN in any other joints in addition to your knee?
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_swank_ responded:
Your doctor is correct but you should always get opinions from other doctors before considering serious surgery. Age 57 is not too young for a knee replacement, not even close. Especially in a case like yours where you have no choice. It must be done. There is no magic age for a knee replacement, it's a quality of life issue. I had a partial replacement just short of my 49th birthday.

You should be concentrating your time on getting a good surgeon at this point.
 
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tfjoplin responded:
I've had both hips replaced due to avascular necrosis. I'm the same age as you. Doctors do not know why I got it, but feel it won't come back in any other joint. I also would encourage a consultation with another doctor. You may be opposing information. You can go onto Google and query on Hip Replacement Support Group. There's one that will come up and it's excellent. They do sometimes discuss knees. These are people that have been through it so compare their info to the docs. My doctor is great. He told me all the options, the plusses and minuses of each option, and his recommendation. I studied the support group info extensively and found my doctor was 100% correct.
 
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TiffParsons responded:
Wow I just lost a Long message I tried to post to reply to badguy1952 ... bummer. So I will keep this one short:

I am 39 years old with AVN in my hip, with no real obvious cause. I was scheduled for a hip replacement but will be having a "Core Decompression" on Monday (wish me luck!) . The idea is to get the blood recirculation and then reinforce the bone drill hole with a titanium tube or something. Hopefully this will save my hip.

Another procedure that was discussed was a Bone Graft of some sort, but the recovery time would have been a lot longer and the outcome less certain. At least with the replacement, you know it's FIXED and will not come back to that joint.

Like with any ailment, the most important thing is having a doctor you like, who really thinks about your INDIVIDUAL well being. My local guy is great and I am thrilled he will be doing my surgery. He had referred me to a big practice in Baltimore to see about the bone graft, and I felt like I was in a "mill" ... just a number, so try to avoid that if you can. If you don't like your doctor, ask yourself if he/she is thinking about your specific case, or if it's just that you don't like what you are hearing, you know?

As with life, I always say "It's all about relationships".

Good luck, and please let me know what you decide to do.
 
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Glitteringglory responded:
I am wondering how the "Core Decompression" surgery went? I just turned 34 and was diagnosed with avacular necrosis. I had a MRI to confirm it. I had legg perthes as a child and was surprised to hear my hip is deteroriating again! To make all of this even weirder, I am female and I see these things usually show up in males. Like you, there seems to be no cause for this. I see my othopedic Tuesday. I feel a bit stressed about the whole thing but hope to get some answers, soon. I would like to avoid hip replacement surgery or any other type of surgery if possible.
 
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bionic_hip_man responded:
Glitter I had AVN in both hips from epidural steroid injections. A core dec. consists of once the femur is exposed they use a large drill to access the interior of the femur head. Once access is gained a tool is used to scrape the necrotic bone tissue out, basically hollowing out the femur head. After this usually donor bone or bone harvested from you is packed into the hollowed out space. I'm not trying to scare you but I have had bilateral core dec. and they were not successful. I have also had 2 total hip replacements and 3 revisions and the core decompression surgery was the WORST pain I have ever had after surgery and during recovery for months. I was 33/34 when I had my first replacements and they wore out because I had a very physical job at the time.
 
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LilYoungLady replied to tfjoplin's response:
I have bilateral AVN in my hips. My surgeon suspects that it is from Alcohol. I was on Steroids as a child, I drank in my 20's (as did everyone else I know) and I just gave birth to a child 3 months before I started have weight bearing pain. I experience the "pulled groin" like pain in my last month of pregnancy. Its so frustrating that no doctor can tell me what caused this for sure! My primary doctor is testing me for every disease in the book b/c he doesnt think the alcohol cause stands up. I've had the core decompression already and I started having pain again two months later. I just received a cortisone shot a week ago b/c I couldnt walk. How did your hip replacements go? recovery time?
 
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_swank_ replied to LilYoungLady's response:
Your doctor can't tell you the cause because they don't really know for sure what causes it. Steroids are suspected in many cases. I seriously doubt drinking in your 20's caused it. If that were true there would be a lot more cases of AVN. It's still relatively rare. At this point it doesn't really matter anyway. Just concentrate on finding a good doctor to do the replacements.
 
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equinetta replied to bionic_hip_man's response:
Bionic hip man - I realize this is 2 years since your post, but I'm interested in knowing more about your development of AVN after epidural injections. There are NO cases reported in the literature, but it is a presumed risk. Would you be willing to share how many epidural injections you received before developing AVN? You were quite young. Did you have any other "risk factors?"
 
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Quartni responded:
Hey, I am a 30 year old female and have AVN of the femoral head in my left hip. I had a core decrompression done in Jun 2012 and it did resupply the blood however when the top of my femur originally began to die and decay, a fracture was created between the alive and dead bone. When the blood began to resupply after the decrompression, the fracture is pushing apart rather than fusing together. I am scheduled for a THR Oct 15. I go on the 8th to get all the details from my doctor. Also, the original MRI that diagnosed my AVN on the left showed that I have also had it in the right hip but it has begun to heal itself. I have never had any pain in my right hip. The pain I had before my first surgery is the same now that it has healed. My hip pops about every 15 minutes and I walk with a really bad limp that resembles one of my legs being shorter. I opted for the THR bc I am young and have small children and this pain does not fit well into my lifestyle and neither does the amount of pain meds I need to ease this pain. Hope this helps and if you'd like I will update you of my progress once I have the replacement. Also, know that I have none of the risk factors for AVN...severe alcoholism, prior hip trauma, osteoporosis, AIDS/HIV, Sickle cell Anemia, anabolic steroid use and I am a female. My surgeon has been in practice for 28 years and I am the youngest patient he has seen with AVN this progressed for no reason. Yay for Me, lol.
 
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Quartni replied to TiffParsons's response:
I also had a core decrompression in June of this year. It did correct the blood flow issue in my left hip but, I had a fracture that was created when the head of my femur died (almost 1" ) between the dead and alive bone. Once the blood began to reflow and the bone began to heal, the fracture is being pushed apart rather than fusing together. I am only 30 so I opted for a THR which I am having Oct 15. Good Luck with your surgery, the crutches for 6 weeks sucks, but it did correct the AVN within weeks. Also, the titanium tube in a decompression replaces the bone graft from a real bone. My surgeon said that a real bone graft would take longer to heal than from the surgery.
 
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undefined responded:
HI..THIS PAST OCTOBER MY KNEE HURT AND PROGRESSIVELY WORSENED.MRI INDICATED AVN .fIRST MD TAKE MOTRIN AND OFF FEET FOR 3 WEEKS.cALLED PRIMARY AND RECOMMENDED MD AT HOSPITAL FOR SPECIAL SURGERY IN NYC.fIRST VISIT PUT ME ON CALCIUM,VIT D 4000,MIACALCIN.TWO WEKS LATER SAID WE WILL DO CORE DECOMPRESSION SURGERY ON DEC.11.i AM ALMOST WALKING AGAIN.MD IS JOSEPH LANE
212-606-1172..HE WAS A GODSEND.NO REPLACEMENT..YOU ARE TOO YOUNG


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