Rationale for prostaglandin I2 in bone marrow oedema--from theory to application.
BACKGROUND
Bone marrow oedema (BME) and avascular osteonecrosis (AVN) are disorders of unclear origin. Although there are numerous operative and non-operative treatments for AVN, pain management in patients with AVN remains challenging. Prostaglandins play an important role in inflammatory responses and cell differentiation. It is thought that prostaglandin I2 ([PGI2] or synonoma prostacyclin) and its analogues promote bone regeneration on a cellular or systemic level. The purpose of this study was to assess the curative and symptomatic efficacy of the prostacyclin analogue iloprost in BME and AVN patients.


METHODS
We are reporting on 50 patients (117 bones) affected by BME/AVN who were treated with iloprost. Pain levels before, during and 3 and 6 months after iloprost application were evaluated by a visual analogue scale (VAS). The short form(SF)-36 health survey served to judge general health status before and after treatment. Harris Hip Score (HHS) and Knee Society Score (KSS) were performed as functional scores and MRI and X-rays before and 3 and 6 months after iloprost application served as objective parameters for morphological changes of the affected bones.


RESULTS
We found a significant improvement in pain, functional and radiological outcome in BME and early AVN stages after iloprost application, whereas patients with advanced AVN stages did not benefit from iloprost infusions. Mean pain level decreased from 5.26 (day 0) to 1.63 (6 months) and both HHS and KSS increased during follow-up. Moreover, the SF-36 increased from 353.2 (day 0) to 560.5 points (6 months). We found a significant decrease in BME on MRI scans after iloprost application.


CONCLUSIONS
In addition to other drugs, iloprost may be an alternative substance which should be considered in the treatment of BME/AVN-associated pain.
Jäger
Marcus
M
Department of Orthopaedics, Heinrich-Heine University Hospital Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany. Jaeger@med.uni-duesseldorf.de
Tillmann
Frank Peter
FP
Thornhill
Thomas S
TS
Mahmoudi
Marcus
M
Blondin
Dirk
D
Hetzel
Gerd Rüdiger
GR
Zilkens
Christoph
C
Krauspe
Rüdiger
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases / Q000188:drug therapy* / Q000473:pathology; D004487:Edema / Q000188:drug therapy* / Q000473:pathology; D011464:Epoprostenol / Q000031:analogs & derivatives* / Q000378:metabolism; D005260:Female; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000188:drug therapy* / Q000473:pathology; D010147:Pain Measurement; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020127:Recovery of Function / Q000187:drug effects
D010975:Platelet Aggregation Inhibitors; D011464:Epoprostenol; D016285:Iloprost