title: Bone marrow edema syndrome of the femoral head: treatment with the prostacyclin analogue iloprost vs. core decompression: an MRI-controlled study.
abstract: BACKGROUND
  The purpose of this study was to assess the efficacy of the vasoactive drug iloprost in Bone Marrow Edema Syndrome (BMES) and to compare it to the results of a control group treated by core decompression.
  
  
  METHODS
  38 hips (36 patients) with BMES in the femoral head were investigated. In group A, 18 hips (17 patients; mean age 49 years) 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 microg iloprost over 6 hours on 5 consecutive days. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. In group B, 20 hips (19 patients; mean age 41 years) underwent surgical core decompression of the femoral head followed by 6 weeks of partial weight bearing. Both groups were evaluated clinically, radiographically and by MRI.
  
  
  RESULTS
  In group A, one patient had to discontinue therapy on the first day because of severe headache. In the remaining patients the Harris Hip Score (HHS) improved from a mean of 64.7 points (range 44-89) before therapy to 97.0 points (83-100) after 3 months. MRI controls showed complete remission in all hips. In group B, the preoperative HHS improved from 53.7 points (31-82) to 95.1 points (39-100) after 3 months. MRI controls showed complete remission of BMES in 14 hips, residual focal bone marrow edema in four hips and a small osteonecrotic area in two hips. In both groups the high level of clinical recovery was maintained at the last examination after a mean follow up of 11 months in group A and 12 months in group B.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1st Department of General Orthopedics, Orthopedic Hospital Vienna-Speising, Vienna, Austria. nicolas.aigner@aon.at
authors.forename: Nicolas
authors.initials: N
authors.lastname: Aigner
authors.forename: Gert
authors.initials: G
authors.lastname: Petje
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneider
authors.forename: Roland
authors.initials: R
authors.lastname: Meizer
authors.forename: Matthias
authors.initials: M
authors.lastname: Wlk
authors.forename: Spyridon
authors.initials: S
authors.lastname: Kotsaris
authors.forename: Karl
authors.initials: K
authors.lastname: Knahr
authors.forename: Franz
authors.initials: F
authors.lastname: Landsiedl
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000473:pathology / Q000628:therapy; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000628:therapy*; D019299:Decompression, Surgical / Q000379:methods*; D004487:Edema / Q000175:diagnosis* / Q000628:therapy*; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005270:Femur Head / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013577:Syndrome; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D011464:Epoprostenol; D016285:Iloprost