Generally, **knee necrosis** disease is one of the most painful diseases that occurs due to the disruption of blood flow to the knee bones. This disorder causes death and leads to bone death of the knee. It causes damage to the spine to the knee joint and ultimately leads to painful events in the knee joint, this disease is seen severely in women and the elderly. Necrosis occurs in one knee and usually involves the inner condyle of the femur. Causes of knee necrosis The main cause of this disease is still unknown, but some factors can help increase it. Necrotic disease occurs when there is no or reduced blood flow to the bone, which can occur for the following reasons: ### joint or bone trauma An injury such as a sprained joint can damage nearby blood vessels. Cancer treatment with radiation therapy can also weaken bone and damage blood vessels. ### Deposition of fat in blood vessels Fat (lipids) can clog small blood vessels. This reduces blood flow to the bones. ### specific diseases Diseases such as sickle cell anemia and Gaucher's disease can also reduce blood flow to the bone. Additionally, corticosteroid medications used by people with asthma and rheumatoid arthritis can reduce blood flow to the knee joint. Sometimes the cause of non-traumatic osteonecrosis of the knee is not exactly known. Genetics, excessive alcohol consumption, certain medications, and other diseases can also play a role. Symptoms of knee necrosis The first symptom of this disease is sudden pain in the knee. This pain occurs when bearing the weight of climbing stairs and at night more than during the day, and its intensity increases. In the sample and limited to the location of the lesion, other symptoms include: - Sensitivity of the knee and its surroundings to the touch - Knee swelling - Reduce movement restrictions - Knee joint after pain This disease may last for several months and early diagnosis of the disease is very important. It is seen in some studies that early diagnosis and treatment have very good results in its treatment. Unexplained necrosis of the knee usually occurs with pain in the inner part of one of the knees. Knee pain starts suddenly and worsens at night and when the knee is under pressure. Sometimes the pain caused by knee necrosis is similar to the pain of a meniscus tear, this secondary pain occurs gradually. Usually, pain occurs in the inner part of the knee and pain does not occur in the outer part. A person suffering from secondary necrosis has pain in other joints of the body, including the thigh. Because these disorders involve a large number of joints in the body, if this pain occurs one day after surgery, it causes pain in the inner part of the knee, and it occurs suddenly 6 to 8 weeks after surgery. Diagnosis of knee necrosis During a physical exam, your doctor will apply pressure around your joints and check for tenderness. He may also move the joints into different positions to see if your range of motion is reduced. Many diseases can cause joint pain. Imaging tests can help determine the source of your knee pain. These tests include: ### X-ray photography These tests can show the bone changes that occur in the later stages of osteonecrosis of the knee. In the early stages of the disease, X-rays usually do not show any problems. ### MRI and CT scan MRI and CT scan can provide detailed images of early bone changes. ### Bone scan A small amount of radioactive substance is injected into the vein. The tracer moves to areas of the bone that are damaged or healing and show up as bright spots on the imaging scan. ### radiography Radiographs can be seen in epi and lateral views of the knee. In the advanced stages of the disease, bone changes can be seen in the radiographs and the process can be seen. Treatment of knee necrosis The treatment of knee necrosis depends on the stage of the patient and the size of the bone involvement. In the initial stages of this disease, non-surgical treatment is performed in such a way that the scope of the involvement is very small. Non-surgical treatment includes non-steroidal anti-inflammatory drugs that reduce pain and inflammation. Using crutches makes the knee bear less weight and as a result, the process of its destruction decreases. Exercises are useful for strengthening thigh muscles and increasing knee movements. Exercising in water is recommended to reduce the pressure on the joint. Reducing activities such as climbing stairs can help with treatment. Bisphosphonate drugs prevent the loss of bone mass by inhibiting osteoclasts. Research shows that these drugs help reduce joint collapse in patients and thus delay surgery and knee replacement. ### drug therapy In the early stages of avascular necrosis of the knee, some drugs can help reduce symptoms: Over-the-counter medications such as ibuprofen or naproxen may help relieve pain. Stronger NSAIDs are available with a prescription. Osteoporotic drugs may slow the progression of avascular necrosis. Cholesterol-lowering medications may help prevent blood clots that can cause osteonecrosis of the knee by lowering cholesterol and blood fat levels. Medicines that open blood vessels, such as iloprost (Ventavis), may increase blood flow to the affected bone. For blood clotting disorders, blood thinners such as warfarin can prevent blood clots in the blood vessels that feed the bone. ### Physiotherapy of knee necrosis One of the non-surgical methods that is very effective is physiotherapy and it relieves pain and prevents bone injuries. It cannot eliminate all injuries in general. In the first session, the physiotherapist performs the necessary evaluations and checks the knee's ability to move and prescribes the necessary movements to the person accordingly. Using an ice compress is a very useful method in reducing pain after physiotherapy, of course, using a warm compress can also be soothing. The main goal of physiotherapy in this case is to strengthen the muscles around the knee, improve the movement of the knee joint and reduce pain and inflammation. Below are some common techniques used in physical therapy to treat osteonecrosis of the knee: - Strengthening exercises: Strengthening exercises focus on strengthening the muscles around the knee, such as the thigh and calf muscles. These exercises include proper movements and weight lifting to improve muscle strength and bone strength. - Flexibility exercises: Flexibility exercises help to improve the flexibility and elasticity of the muscles and tissues around the knee. These exercises include stretching exercises and the use of techniques such as stretching. Balance and motion control exercises: Exercises that focus on balance and motion control help improve knee motion control and prevent other injuries associated with knee osteoarthritis. - Massage and manual techniques: Massage and manual techniques can be effective in reducing knee pain and inflammation. These techniques include massaging the muscles and tissues around the knee and manual techniques such as deep tissue massage, scar massage, and lymphatic massage. - Use of additional equipment and exercises: Using equipment such as wings, trampolines and physiotherapy balls can add variety to exercises and increase the speed of recovery. ### Ozone therapy In this method, ozone, which consists of three oxygen atoms, is used to regenerate and restore damaged tissues and joints. This treatment method is an anti-inflammatory treatment that is performed by injecting collagen into the connective tissues of the body under the guidance of an ultrasound machine, which causes the production of gas and ozone in the tissues and the regeneration of damaged tissues and weak tissues around the joints. These substances are injected into the damaged tissues or around the joint and cause the regeneration of these areas. In some cases, at the doctor's discretion, gel is also injected into the joint at the same time. ### Shockwave therapy This method is useful in the early stages of avascular necrosis of the femoral head. Treatment with external shock waves can reduce pain and improve hip joint function, can cause regression of avascular necrosis. ### knee necrosis surgery If the level of involvement is high or the treatment does not improve with non-surgical treatments, surgery is recommended. Surgical treatments include the following #### Unilateral knee joint replacement In cases where a small and limited pain has not been seen, this method can be used. In this method, the damaged part is removed with a knife and replaced with a metal and compressed plastic prosthesis. #### Total knee joint replacement In cases where the conflict is beyond this condyle and a complete knee replacement is needed, this method is used. #### Upper or distal femur osteotomy In cases where the osteotomy creates a bracketed foot or valgus, which is also a crossed foot. This method is used to correct the angle of the lower limb. In general, the knee is the biggest and strongest joint in the whole body. This bone is formed from the end of the lower part of the femur to the top of the tibia and patella. The ends of these three painful bones, which are in conflict with each other, are covered by an articulating rod. The slippery substance protects the bones and enables them to slide easily against each other during movement. ### bone graft Bone grafting is one of the treatment methods for healing and necrosis of the knee. In this medical method, the dead bone is completely removed and healthy tissue and bone from other parts of the body are used to replace the tissue. Bone grafting protects weak bone tissue. ### Decompression surgery Pressure is the simplest and most common type of treatment methods in this regard, in which the doctor uses one or more holes on the knee to help measure the internal pressure of the bone. With this treatment method, it relieves pain and stimulates its process. Knee necrosis healing process The natural course of osteonecrosis of the knee is different from osteonecrosis of the hip. Up to 50% of patients with idiopathic osteonecrosis recover in the pre-radiological period and do not develop arthritis. The most important factor determining the recovery rate is the size of the lesion. Patients with secondary osteonecrosis have a worse prognosis. As a result, today, due to advances in radiological imaging methods, it has become much easier to diagnose spontaneous osteonecrosis of the knee joint, except in the early stages. Despite the technological advances that provide such important information to the orthopedic surgeon, there is still no consensus on treatment, except for the first stage of necrosis. At this stage, the most important point that guides the surgeon in treatment decisions will be his clinical observations and personal experience. —————————————————————– Ways of communication with Dr. Majid Ghorbanzadeh The Instagram page of Dr. Majid Ghorbanzadeh Aparat channel of Dr. Majid Ghorbanzadeh The show channel of Dr. Majid Ghorbanzadeh —————————————————————–