Avascular Necrosis of the Femoral Condyle: Treatment Options and Recovery

Q: Avascular Necrosis of the Femoral Condyle: Treatment Options and Recovery

Hello： If the MRI shows early-stage osteonecrosis of the medial condyle, conservative treatment can be employed, which includes non-weight bearing with crutches, along with regenerative treatments such as platelet-rich plasma (PRP) therapy and hyperbaric oxygen therapy. <br>Arthr

Avascular necrosis of the femoral condyle?

Hello Dr.
Chen,
My mother suddenly fell on the street due to knee pain while walking six months ago.
At that time, she had an X-ray examination at a nearby orthopedic clinic, but the doctor did not find any abnormalities.
Due to the pandemic, she delayed visiting a rehabilitation department until two months ago for about two months of therapy, but there was no improvement.
On October 20, she visited the orthopedic department at Tri-Service General Hospital Songshan Branch again and underwent an X-ray examination.
The doctor diagnosed her with "avascular necrosis of the medial femoral condyle" based on the X-ray findings and recommended surgical treatment (the doctor mentioned that due to the large area of necrosis, a minimally invasive surgery would be performed).

I would like to ask the doctor the following questions:
1.
Is surgery the only treatment option for avascular necrosis of the medial femoral condyle? After surgery, what percentage of function can be expected to recover?
2.
According to the initial assessment by the doctor, if treated with medications covered by health insurance, the cost would be fully waived; however, if using self-paid medications (or materials, my mother couldn't clarify), recovery would be faster but would cost over 300,000 NTD.
What is the difference between choosing self-paid medications or materials? My mother forgot to ask the doctor at that time.
3.
Is it possible to avoid surgery and use PRP therapy instead?
Thank you, doctor.

A Yan, 30~39 year old female. Ask Date: 2021/10/25

Dr. Chen Bochen reply Orthopedics

Hello: If the MRI shows early-stage osteonecrosis of the medial condyle, conservative treatment can be employed, which includes non-weight bearing with crutches, along with regenerative treatments such as platelet-rich plasma (PRP) therapy and hyperbaric oxygen therapy.
Arthroscopic surgery may also be considered.
However, if there is already bone or cartilage collapse, joint replacement is necessary, or one might consider new stem cell therapies (the 300,000 you mentioned is likely referring to this, which usually needs to be combined with arthroscopic surgery).

Reply Date: 2021/10/25

More Info

Avascular necrosis (AVN) of the femoral condyle, also known as osteonecrosis, is a condition that occurs when there is a loss of blood supply to the bone, leading to bone death and potential collapse. This condition can significantly impact mobility and quality of life, particularly when it affects weight-bearing joints like the knee. Given your mother's situation, it is crucial to understand the treatment options and recovery expectations associated with AVN.

Treatment Options for Avascular Necrosis
1. Non-Surgical Treatments: In the early stages of AVN, non-surgical options may be considered. These include:
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain. Bisphosphonates and other medications may also be prescribed to slow the progression of bone loss.

- Physical Therapy: Rehabilitation exercises can improve joint function and strength, although they may not reverse the necrosis.

- Activity Modification: Reducing weight-bearing activities can help alleviate pain and prevent further damage.

2. Surgical Treatments: When non-surgical methods fail or if the AVN is advanced, surgical intervention is often necessary. The options include:
- Core Decompression: This minimally invasive procedure involves removing a portion of the inner bone to reduce pressure and promote blood flow.

- Bone Grafting: In this procedure, healthy bone is transplanted to the affected area to support healing.

- Total Knee Replacement: In severe cases where the joint is significantly damaged, a total knee replacement may be necessary.

Recovery Expectations
The recovery process after surgery for AVN can vary widely based on the extent of the necrosis, the specific surgical procedure performed, and the patient's overall health. Generally, patients can expect:
- Initial Recovery: The first few weeks post-surgery will involve rest and limited weight-bearing on the affected leg. Physical therapy will typically begin shortly after surgery to regain range of motion and strength.

- Long-Term Recovery: Full recovery can take several months, and many patients regain a significant portion of their knee function. However, complete recovery may not be guaranteed, especially if the necrosis was extensive.

Cost Considerations
Regarding the treatment costs, it is essential to clarify the differences between insured and self-pay options:
- Insurance Coverage: If the treatment is covered by health insurance, it can significantly reduce out-of-pocket expenses. This typically includes standard surgical procedures and medications.

- Self-Pay Options: Self-paying for advanced treatments or materials (such as certain types of grafts or biologics like PRP - Platelet-Rich Plasma) may offer faster recovery or improved outcomes but can be costly. It is crucial to discuss with the physician what these options entail and their potential benefits versus risks.

PRP Therapy
PRP therapy is a regenerative treatment that uses components of the patient's blood to promote healing. While some studies suggest it may help in managing pain and improving function in early-stage AVN, it is generally not a substitute for surgical intervention in advanced cases. Discussing this option with the orthopedic surgeon is essential to determine its appropriateness based on your mother's specific condition.

Conclusion
In summary, the treatment of avascular necrosis of the femoral condyle often requires a tailored approach based on the severity of the condition. While non-surgical options may be effective in the early stages, surgical intervention is frequently necessary for advanced cases. Recovery can be a lengthy process, and understanding the financial implications of treatment options is crucial. It is advisable to have a thorough discussion with the orthopedic surgeon to clarify the best course of action for your mother's specific situation.

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