Avascular necrosis - A pre-surgical update

Avascular necrosis is a disease where cellular death of bone components occurs due to the lack or interruption of blood supply. Without proper blood supply, the bone tissue dies and bone collapse and fracture. In cases of avascular necrosis involving bones of a joint, it usually leads to destruction to the joint surface.

There are at least 15 didn’t factors that can cause avascular necrosis. Three of which, I have been exposed to. They include chemotherapy, radiation, and prolonged steroid use.

Today was my last pre-surgical consult. I scheduled the appointment, so there would be no surprises upon walking in the operating room. The plan for the right knee is still same. Drain (or aspirate) fluid from the joint and inject a cortisone shot. That’s the easy part. The left leg gets tricky.

I know my bout with cancer was rare and we were sailing unchartered waters. What I didn’t know was we are now doing the same with the left leg. He’s never performed this surgery on a patient with avascular necrosis. Apparently, there is a difference when repairing a bone that was broken by falling, sports, or being beaten in an alley with a pipe, then one with bone necrosis.

He gave an 85% chance it “could” be successful, or in the least buy me a little time before a full prosthetic knee replacement. This is a complicated surgery. There is a lot of stuff going on. There is NO physical therapy until I’m off crutches. It wouldn’t really matter anyway. We aren’t trying to strengthen surgically repaired muscle; we are trying to build bone. Is anyone catching my drift?

Theoretically, the procedure makes sense. Scope the knee to assess the complete damage. Make one 1” incision on both sides of the knee. Drill two holes into my fractured fibula. Take a sizeable bone graft from the right hip. Pack those two holes with as much bone graft as possible. Insert two large screws along the top of the bone, just below the knee joint to structurally stabilize the bone from collapsing. It is sound theory, but very risky.

Ok, that is all the semi-bad and medical information. Here’s the good news. I trust my surgeon. He is the only of three orthopedists, who gave me an alternative to a total knee replacement. I am young and don’t take much if any pain medication currently. This increases my chances of success. I’ll be partial weight bearing for 6 weeks on crutches or with a walker. That is my decision.

Sometimes you have to take a leap of faith. I did when I fought Mantle Cell and will when my leg is reconstructed. I have the strength and the will to do it. Either way, you haven’t heard the last of me.

Cheers.