Bone marrow edema syndrome of the femoral head

Aigner, N; Petje, G.; Schneider, W.; Meizer, R; Wlk, M; Kotsaris, S; Knahr, K.; Landsiedl, F

doi:10.1007/s00508-005-321-3

Cited by 70 publications

(18 citation statements)

References 31 publications

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“…MRI was used to document the regression of the disease during the observation period. In a recent study comparing core decompression with treatment with parenteral iloprost, Aigner36 could show that all patients with bone marrow edema syndrome without demarcation of necrotic areas treated with iloprost yielded the same excellent results with a highly accelerated recovery compared to core decompression. Furthermore, most patients resumed normal daily activities earlier.…”

Section: Discussionmentioning

confidence: 99%

Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

et al. 2009

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Background:Bone marrow edema (BME) is a common cause of hip pain. The aim of the study was to assess the efficacy of the vasoactive drug iloprost in the treatment of BME of femoral head.Materials and Methods:We reviewed 27 patients (19 male, 8 female) with BME of the femoral head. Their mean age was 53.7 ± 10.8 years. All patients were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 to 50 μg iloprost over 6 h on 5 consecutive days each. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. Pain at rest as well as under stress was assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy.Results:At the clinical follow up of four months after therapy, the pain level at rest had diminished by a mean of 58.3% (P < 0.0001). Pain under stress decreased by a mean of 41.9% (P < 0.0001). On MRI, 20 patients had a significant reduction of BME size or complete normalization and 4 showed no change. Worsening of the MRI pattern was found in 3 patients.Conclusion:The authors conclude that the use of parenteral iloprost might be a viable method in the treatment of BME of femoral head.

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Section: Discussionmentioning

confidence: 99%

Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

et al. 2009

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“…Recently, vasoactive prostacyclin derivatives have been used in bone marrow edema patients to dilate the arterioles and venules. In a study comparing the effects of vasoactive prostacyclin derivatives and decompression, both groups showed a fast clinical recovery, whereas the patients treated with vasoactive prostacyclin derivatives showed a faster healing of the bone marrow edema [ 24 ]. The follow-up course of our patients who had not undergone a biopsy included administration of NSAIDs and restriction of weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

Painful transient edema in the tibial diaphysis: the challenges and the essence of biopsy in treatment

et al. 2018

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BackgroundSome patients experience a non-traumatic pain in the tibial diaphysis similar to that in the clinical and radiological findings of a tumor, an infection or a stress fracture and cannot be definitively diagnosed even after biopsy.In this study, our aim was to exhibit the challenges in the diagnosis of this patient group and to evaluate this type of patients with a limited population in the literature.MethodsEighteen extremities of 16 patients, whose complaints of non-traumatic pain in the tibial diaphysis were evaluated by our tumor council and T2-weighted MR scans of the medullary bone had shown hyperintense signal changes or tumor-like appearances, were evaluated with histological, radiological, and clinical results.ResultsLesions were detected in 18 extremities of the 16 patients (seven males, nine females; mean age 23 [range 7 to 51] years). Four of the lesions were in the right tibial diaphysis, ten were in the left, and two were bilateral. Laboratory findings of the patients were normal. Based on the decision of the tumor council, biopsy was performed on 12 patients. All patients’ complaints were gone and MRI findings decreased during the follow-up period. The complaints of the three patients who did not have a biopsy decreased after a mean period of three months.ConclusionsMedullary stress syndrome has been reported in the literature in various forms and in a limited number of cases, including longitudinal stress fracture and transient medullary edema of the bone. In light of our findings, we deduced that biopsy of the diaphyseal lesions in this patient group is essential and that the complaints of this patient group declined in the earlier term in comparison to the patients who were not performed biopsy.

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“…Furthermore, Aigner et al . 40 compared the results of Iloprost with core decompression in patients with bone marrow edema syndrome. The authors reported the parenteral application of Iloprost resulted in equal or better results compared to core decompression at 3 months comparing the Harris hip score and MRI findings post treatment.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis

2016

Orthop Rev

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The treatments of avascular osteonecrosis (AVN) include both conservative and surgical methods which are dependent on the stage and progression of the disease. The vasoactive-prostaglandin-analogue iloprost (PGI2) has been utilized in several areas of medicine and recently has been used for the treatment of AVN. A total of 108 patients with 136 osteonecrosis of different joints, etiology and severity were treated with iloprost. The mean follow-up was 49.71 months: range 15-96 months, and outcome measurements recorded regarding subjective complaints, visual analog scale (pain), function and survival. The outcome scores used include the Harris Hip Score, Knee Society score, Foot and Ankle Survey, visual analogue scale (VAS) and a separate questionnaire. The location and etiology of AVN in our study demonstrated the typical pattern. All of the observed side effects of the therapy were minor and completely reversible. Most of patients (74.8%) showed a significant improvement of subjective complaints and decrease in VAS pain scores after the treatment with iloprost. However, 20% of the treated joints with the stadium Association for Research on Osseous Circulation (ARCO) grade 2, 71% with ARCO 3 and 100% with ARCO 4 underwent subsequent total joint replacement. The medical treatment of bone marrow edema or avascular osteonecrosis by Iloprost provides an safe and effective alternative strategy in the management of AVN presenting in the early stages (ARCO 1 or 2). For more advanced stages (ARCO 3 or 4), surgical intervention should be prioritized.

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Bone marrow edema syndrome of the femoral head

Abstract: The parenteral application of iloprost can achieve equal or better results in the treatment of bone marrow edema syndrome of the hip compared to core decompression.

Cited by 70 publications

References 31 publications

Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

Painful transient edema in the tibial diaphysis: the challenges and the essence of biopsy in treatment

Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis

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