Core decompression of the hip, Part 2greenspun.com : LUSENET : About Joints : One Thread
Dear Dr Khanuja, Thank you for your reply to my recent question on core decompression of the hip, however I did not phrase my question correctly. What I meant was how long would it take for signs of actual bone regeneration or for new cells to appear? Having had core decompression of bilateral knees myself, I was told that the reason for this surgery was two-fold: to reduce inner bone pressure, and to encourage bone cell growth. In my case, the surgery was a failure in bone growth terms. While it did reduce the inner pressure, thus reducing overall pain levels, it did nothing to help my bones to grow new cells. My right knee was ultimately replaced in 2000, and my left one will be done next month. So, then, what kind of time frame are we looking at for the femur to hopefully grow new bone cells, assuming that will happen at all?
Marie Shanahan ON/AVN Support Group Int'l, Founder/Director, and NONF, Director
-- Marie Shanahan (AVNrie@aol.com), July 22, 2003.
-- Marie Shanahan (AVNrie@aol.com), July 29, 2003
The "decompression' part of core decompression is something that always occurs. Therefore almost all patients, no matter what stage of the disease, initially get at least some relief of their symtoms. We also know that the 'wound' of the core decompression, stimulates new blood vessels to grow, much like the pruning of a tree, or bush, causes new branches to sprout. New bone forms around the core tract and this can sometimes, but not always, be seen on follow-up x-rays. However, it is unlikely that the dead bone is substantially replaced by the invading blood vessels. It may be stabilized by the bone in the core tracts and that is why patients who have had core decompression tend to do better that patients who have not had cores. The ultimate outcome is probably most importantly affected by the size of the dead bone area and it's position. If the size is large, then core decompression tends to improve things for a while, but the bone ultimately collapses and the symptoms return. The absolute prediction of the course of events is impossible for a specific patient. Because core decompression is a relatively minor surgical procedure with few complications, particularly compared to a total joint replacement, it tends to be offered to patients to 'see how they will do'. If they have a successful outcome, they have been spared a much more extensive procedure (total joint replacement). If they don't do well, then the core does not interfere with subsequent joint replacement surgery. The patient with osteonecrosis needs to be evaluated carefully by a physician who is knowledgeable about all the facets of treatment to develop a 'risk/benefit' profile the is specific for that patient. Not all patients are candidates for core decompression, either because of the degree to which the disease has progressed (Stage) or the size of the lesion.
-- David Hungerford (firstname.lastname@example.org), August 25, 2003.
Dear Dr. Hungerford, Thank you so much for your reply to my question! I wish every doctor would explain the CD in the way you just did. Many of our group members are in a quandry over the CD procedure, and the information they are frequently given is either incomplete, or not explained very well. Thanks again!
-- Marie Shanahan (AVNrie@aol.com), August 26, 2003.