Bone Marrow Edema and Associated Pain in Early Stage Osteonecrosis of the Femoral Head: Prospective Study with Serial MR Images

Koo, Kyung Hoi; Ahn, In Oak; Kim, Rokho; Song, Hae Ryong; Jeong, Soon Taek; Na, Jae Boem; Kim, Yong Sik; Cho, Se Hyun

doi:10.1148/radiology.213.3.r99dc06715

Cited by 132 publications

(86 citation statements)

References 48 publications

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“…Compared with the asymptomatic population the prevalence of bone marrow edema lesions is greater in patients with increased Kellgren-Lawrence grade and subchondral bone may be a major contributor to OA pain [7][8][9]12]. As expected, the preoperative Kellgren-Lawrence OA grade showed an inverse relationship to the postoperative Tegner Lysholm score.…”

Section: Discussionsupporting

confidence: 58%

“…However, using the Tegner Lysholm grading system (Table 1), we found that 10 of the 22 patients had an outcome considered a treatment failure. Percutaneous calcium phosphate injection has a theoretical potential to become a widely used treatment option for patients with subchondral bone marrow edema lesions which are considered a major source of pain in patients with OA [7][8][9]12]. However, the 22 procedures performed at our institution showed only marginal success at short-term followup.…”

Section: Discussionmentioning

confidence: 84%

“…While loss of articular cartilage is the hallmark of OA, there is evidence that damage to subchondral bone can lead to the subsequent deterioration of the overlying articular cartilage [20]. Although pain with OA most likely is multifactorial, subchondral bone, which is highly innervated, may be a major contributor [7][8][9]12]. Fibrovascular replacement of adipose marrow tissue in the bone marrow edema lesion and growth factor expression may promote localized increase of nociceptive fibers [21,29].…”

Section: Introductionmentioning

confidence: 99%

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Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Chatterjee

McGee

Strauss

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Injury to subchondral bone is associated with knee pain and osteoarthritis (OA). A percutaneous calcium phosphate injection is a novel approach in which subchondral bone marrow edema lesions are percutaneously injected with calcium phosphate. In theory, calcium phosphate provides structural support while it is gradually replaced by bone. However, little clinical evidence supports the efficacy of percutaneous calcium phosphate injections. Questions/purposes We asked: (1) Does percutaneous calcium phosphate injection improve validated patient-reported outcome measures? (2) What proportion of patients experience failure of treatment (defined as a low score on the Tegner Lysholm Knee Scoring Scale)? (3) Is there a relationship between outcome and age, sex, BMI, and preoperative grade of OA? Methods Between September 2012 and January 2014, we treated 33 patients with percutaneous calcium phosphate injections. Twenty-five satisfied our study inclusion criteria; of those, three patients were lost to followup and 22 (88%; 13 men, nine women) with a median age of 53.5 years (range, 38-70 years) were available for retrospective chart review and telephone evaluation at a minimum of 6 months (median, 12 months; range, 6-24 months). Our general indications for this procedure were the presence of subchondral bone marrow edema lesions observed on MR images involving weightbearing regions of the knee associated with localized pain on weightbearing and palpation and failure to respond to conservative therapy ([ 3 months). Patients with pain secondary to extensive nondegenerative meniscal tears with a flipped displaced component at the level of bone marrow edema lesions, or with mechanical axis deviation greater than 8°were excluded. All patients had Grades III or IV chondral lesions (modified Outerbridge grading system for chondromalacia) overlying MRI-identified subchondral bone marrow edema lesions. Percutaneous calcium phosphate injection was performed on the medial tibial condyle (15 patients), the medial femoral condyle (five patients), and the lateral femoral condyle (two patients). Concomitant partial meniscectomy was performed in 18 patients. Preoperative and postoperative scores from the Knee Injury and Arthritis Outcome Score (KOOS) and the Tegner Lysholm Knee Scoring Scale were analyzed. Results For patients available for followup, the outcome scores improved after treatment. The KOOS improved from a mean of 39.5 ± 21.8 to 71.3 ± 23 (95% CI, 18.6-45.2; p \ 0.001) and the Tegner and Lysholm score from 48 ± 15.1 to 77.5 ± 20.6 (95% CI, 18.8-40.2; p \ 0.001).

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Chatterjee

McGee

Strauss

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Magnetic resonance imaging (MRI) is a comparatively sensitive diagnostic modality for early diagnosis of osteonecrosis (Vande Berg et al, 2006;Koo et al, 1999;Sakaia et al, 2000). However, unless reparative tissue appears in stage 1, conventional MRI is not believed to detect necrotic lesions in stage 0 of the ARCO (Association Research Circulation Osseous) international classification (Uberoi et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

Relationships among magnetic resonance imaging, histological findings, and IGF-I in steroid-induced osteonecrosis of the femoral head in rabbits

Chen

Weng

et al. 2008

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To study the relationships among magnetic resonance imaging (MRI), histological findings, and insulin-like growth factor-I (IGF-I) in steroid-induced osteonecrosis of the femoral head in rabbits. Methods: Thirty rabbits were randomly divided into experimental Group A (n=15) and control Group B (n=15). The 7.5 mg/kg (2 ml) of dexamethasone (DEX) and physiological saline (2 ml) were injected into the right gluteus medius muscle twice at one-week intervals in animals of Groups A and B, respectively. At 4, 8 and 16 weeks after obtaining an MRI, the rabbits were sacrificed and the femoral head from one side was removed for histological study of lacunae empty of osteocytes, subchondral vessels, and size of fat cells under microscopy, and the femoral head from the other side was removed for enzyme-linked immunoadsorbent assay (ELISA) for IGF-I. Results: At 4, 8 and 16 weeks after treatment, no necrotic lesions were detected in Group B, while they were detected in Group A. Light microscopy revealed that the fat cells of the marrow cavity were enlarged, subchondral vessels were evidently decreased, and empty bone lacunae were clearly increased. The IGF-I levels in Group A were significantly higher than those in Group B. At 8 weeks after the DEX injection, the MRI of all 20 femora showed an inhomogeneous, low signal intensity area in the femoral head, and at 16 weeks, the findings of all 10 femora showed a specific "line-like sign". The MRI findings of all femora in Group B were normal. Conclusion: MRI is a highly sensitive means of diagnosing early experimental osteonecrosis of the femoral head. However, the abnormal marrow tissues appeared later than 4 weeks when the expression of IGF-I increased. This reparative factor has an early and important role in response to steroid-induced osteonecrosis of the femoral head, and provides a theoretical foundation for understanding the pathology and designing new therapies.

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“…It is typified by an "inflammatory pattern" in MRI (low signal intensity in t1-W and high signal intensity in t2-W sequences). typical BMe histological features are not marked by intra or extracellular fluid effusion, but rather depending on the etiology, by fibrosis and inflammatory infiltrate which often reflects the occurrence of pain in the affected bone segment [2,3]. BMeS usually affects the epiphyses of weight-bearing joints-hip, knee, foot and ankle-although it may manifest itself as a "migratory" BMe with multiple episodes in different locations [4,5].…”

mentioning

confidence: 99%

Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip

et al. 2014

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Bone Marrow Edema and Associated Pain in Early Stage Osteonecrosis of the Femoral Head: Prospective Study with Serial MR Images

Abstract: The results of this study suggest that the combination of marrow edema of the proximal femur and focal osteonecrosis of the femoral head are strongly associated with hip pain in early stage osteonecrosis, even prior to collapse. Pain improvement usually parallels the resolution of edema.

Cited by 132 publications

References 48 publications

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Subchondral Calcium Phosphate is Ineffective for Bone Marrow Edema Lesions in Adults With Advanced Osteoarthritis

Relationships among magnetic resonance imaging, histological findings, and IGF-I in steroid-induced osteonecrosis of the femoral head in rabbits

Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip

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