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Has Continuous Pain In Medial Part Of Knee. Undergone A Surgery For Brain Tumour. Report Shows Aneurysmal Bone Cyst. Should I Be Concerned?

Posted on Fri, 23 Aug 2013

Question: Any advice will be appreciated.

This is about my cousin who has started to develop continuous pain in his medial aspect of right knee. Had a surgery around 5-6 years ago for bone tumour.

Pathological diagnosis was Aneurysmal Bone cyst and the pain is in the same place of his right knee. Surgery done was curettage and bone grafting. All the reports are enclosed. And he didn't received any Chemo or radio throughout.

Our concern is he has started developing this ongoing pain even at rest, not relieved with analgesic and the onco surgeon says nothing to worry but another ortho surgeon says it could be the staples inside the leg causing pain and inflammation so go for surgery to remove them.
We are stuck, guide us what could be the best option. I have also enclosed the recent photo of his leg.
Many thanks.

Answered by Dr. Jay Patel (3 hours later)

Hi,

I am dr XXXXXXX and I will try my level best to address your concern.

Now I went through all the images carefully but their is evidence of any staple visible. Their is new imagine technique (EOS imaging) which makes images in 3 D which may give the location of staple if any.

Now about chemo/ radiation- Its not necessary for the kind of tumor he had as its a benign tumor (basically will not spread and can be removed from location via operation)

Now about the pain, many times the nerves that passes in and out are compressed by the formation of new bone tissue, and it will cause pain, the other reason patients may become frustrated, because this benign cyst can return after surgery. It may require two or three operations to eventually get rid of the cyst.

As from the history of having pain at rest, it looks like it may have regrowth of cyst.

AS some of the images are not very clear I would like you to upload the radiologist's report to make it clear. You may need bone biopsy again to check for any regrowth.

Hope it helps. Please feel free to contact me in case of further query or concern.

Thanks for the query.
Dr. XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jay Patel (16 hours later)

Hello Dr XXXXXXX
Many thanks for the infor. I have attached more reports. Ultrasound and X XXXXXXX Onco surgeon did not asked for another biopsy. As he thinks its fine and no need for biopsy.
Do you think a new surgery is necessary for excision of the swelling and staples?
Or are there any alternatives?

Answered by Dr. Jay Patel (12 minutes later)

Hi,

Welcome back, thanks for uploading the report, as per the radiologist report it seems like their is "fasciatis" with the fluid built inside it ( basically means a inflammation of coverings).

Their is a process in which the cuts are made in the covering so that the fluid which is build can be drained out. And the pressure will be released and which in turn will be helpful to decrease the pain (as nerves underneath will have space to breath/expand releasing the compression in other words.).

I will agree to have a smaller operation for releasing the fluid built up will help.

I do see the need to be operated.

Hope it helps, Please feel free to contact me in case of any further concerns.

Thanks again
Dr XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jay Patel (3 days later)

Is there any other way by which this fluid can be resected or it has to be the open surgery only?

Answered by Dr. Jay Patel (44 minutes later)

Hi,

Welcome back, sir your cousin probably has the fasciatis which can be best treated by making cut in the fascia, which in turn will give enough room for underlying muscle to have space to breath, and expand, and I am sorry to say that its the best option.

The fluid built up can be extracted out with needle but it will not help to heal the fasciatis, only remove the fluid.

Please feel free to contact me in case of further concern.

Thanks for showing trust in me and sharing the information,every thing is confidential so please don't worry from my side.

Dr XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jay Patel (12 minutes later)

Many thanks Dr XXXXXXX
He was now referred to pain specialist and had Decdan, Anawin and Mezolam injections but nothing has changed. I have forwarded all the info to him and he will discuss this with his doctor. Ur answers are of great help to him.. Anything else you want him to discuss further?

Answered by Dr. Jay Patel (34 minutes later)

Hi,

I would like you to ask them 4 questions

1) How is the cyst area operate before - is it neat ? (in other words chances of reoccurrence?) since they may make a cut if possible ask them to have biopsy if cost is not much of concern just to be sure things are fine we can't take surgeons word for it.

2) Was it a fasciatis, and what are chances once operated that will not occur again and what care should he take to avoid if any chances to have fasciatis.

3) What was the cause of the fasciatis - ( if a bacterial cause - what type or name of the bacteria).

4) How long the antibiotics will be give once they will cut open and will they have major side effects (like bone marrow suppression in case of some hard core antibiotics).

Please let me know the answer to the question above, if possible.

I appreciate you having concern about your cousin's health. I wish I had a cousin like you.

Thanks again.
Dr. XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jay Patel (3 minutes later)

Many thanks , I will update u by tomorrow

Answered by Dr. Jay Patel (7 minutes later)

Hi,

Thanks for letting me know.

Will talk to you tomorrow once you have acquired the answers. More over if possible can you share your name so that I know whom I have pleasure talking to.

Please don't waste your question today just for letting me know your name I can wait for tomorrow.

Thanks again.
Dr XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jay Patel (2 days later)

Hello again Dr XXXXXXX
Hope you are doing well. My cousin saw the onco surgeon along with few other ortho specialist at Tata Memorial. They have done few more X-rays and now aiming for a surgery, but they said it needs some drilling in the bones and this might ease off the pressure but they can't predict this whether this will be a major or minor surgery until they cut open. They think it can not be fasciatis.
I am unable to speak to the team as the mobile network doesn't seem to be working in their hospital.. Will keep u posted anyway.
By the way, my name is Jivan Sharma and I am based in UK, physiotherapist by profession. And it's been a pleasure to know you.
Many thanks for all the concerns and suggestions.

Answered by Dr. Jay Patel (50 minutes later)

Hi dr.Jivan.

Thanks for letting me know what was going on.

I still fear about the reoccurrence of the cyst, as they want to have those drills is probably a malformed bone or reoccurrence.

Its not possible for any surgeon to say whats going on with out cutting and looking more over as you know imagine techniques just will show shadows only so its hard to predict.

I hope it will be a minor surgery, still it better be prepared for the worst.

Thanks again sir,
Dr. XXXXXXX XXXXXXX .

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar