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avascular necrosis -- knee
May 20, 2004

I, 62 y.o. male, have just been diagnosed with avascular necrosis in the left knee. Do we know the etiology? Is it a result of the regimen (Viread, Emtriva, Viramune), normal hiv progression, or just normal aging? More importantly, can you tell me the prognosis? At present, the ortho does not seem to want to do knee replacement. Can I expect the situation to stabilize or will it progressively get worse? Diagnosis was made by means of mri. Should my hiv doctor be ordering other tests (Dexa, etc.)? Thanks.

Response from Dr. Henry

I have not seen much data nor had any patients with avascular necrosis of the knee in the setting of treated HIV infection. There are many diseases associated with avascular necrosis though some cases have no obvious cause (idiopathic). High lipids, use of steroids have been linked in some studies. In general orthopedic outcomes are usually good in HIV patients-nearly comparable to the general population. The prognosis with conservative treatment is unclear though the pace can be variable. Many recommend early surgical intervention. KH

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