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Osteonecrosis - bone can't replenish and rebuild itself

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Posted on: Thursday, March 21, 2013
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 Hi Jim,

 My husband is a Vietnam Vet and was in Special Forces. He has had chronic pain in his back and knees. He currently gets disability for his knees. In Nov. 2012, he went to the VA for several issues, in an attempt to identify a lump near his abdomen, the CAT scan showed that his hip had disintegrated, he saw an orthopedic surgeon 5 weeks ago, who reviewed the scan and another x-ray from 2005.

 He diagnosed it as osteonecrosis in the one hip, gave him medication and a cane to use until further tests in the other hip and both knees were done to see if these were also affected. Today he had the follow up appointment with the doctor and he now is saying that nothing is wrong, nor is any surgery necessary. This same doctor also remarked at the first visit that this problem was evident in 2005 when they treated my husband for his back. What we can't understand is how this can possibly be true. The damage to the hip is evident. Do you have any advice?

 Reply:

 Osteonecrosis is fairly common. It's also called avascular necrosis. Like so many other conditions, this happens to many of us as we get older. Osteonecrosis is caused when the blood supply to the bones and joints diminishes and the bone can't replenish and rebuild itself. It's a bit like arthritis and is often a component of an arthritic condition.

 Research doesn't pinpoint the causes of the condition but the big risk factors seem to be male gender, steroid treatments, alcohol abuse and treatment of other diseases with chemotherapy or radiation therapy. The usual patient won't ever know a cause, it just happens. If the patient is a tobacco abuser, that may also contribute to the progression of the disease as smoking really hurts the blood vessels.

 The treatment is usually pain relief and lessening of weight bearing...the use of a cane or crutches is front line therapy. Many doctors won't jump to surgery but will delay it until absolutely required.

 I have doubts that this is related to his knees. The knees were probably damaged with the demands of his special forces service. This diagnosis of disease in his hip or hips may be natures way of telling him he's getting older.

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