title: Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot.
abstract: Bone-marrow oedema (BME) represents a reversible but mostly painful increase in interstitial fluid. The exact pathogenetic processes still remain unknown. Treatment options are mainly symptomatic with core decompression as golden standard leading to immediate pain relieve. Recently, it has been shown that intravenous prostacyclin and bisphosphonates are useful in achieving a reduction in BME with a considerable improvement in the accompanying symptoms. We compared the outcome of both intravenously applied prostacyclin (Ilomedin(®), 10 patients) and bisphosphonate (Bondronat(®), 10 patients) in treatment of BME of the knee and foot. We could find a significant improvement of WOMAC score, SF-36 score and VAS 3 months and 1 year after therapeutic intervention in both the prostacyclin and the bisphosphonate group. Concerning the MRI scans in both groups, we found a distinct reduction of BME in 47 % and a complete regression in 40 %. Comparing both groups, the improvement of the scores was greater in the prostacyclin group than in the bisphosphonate group; the difference, however, was not significant. Intravenous bisphosphonates as well as prostacyclin are of efficient therapeutic benefit in treatment of BME with a quicker and greater effect of prostacyclin.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital of Regensburg, Bad Abbach, Germany. dr.clemensbaier@gmail.com
authors.forename: Clemens
authors.initials: C
authors.lastname: Baier
authors.forename: Jens
authors.initials: J
authors.lastname: Schaumburger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Götz
authors.forename: Guido
authors.initials: G
authors.lastname: Heers
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schmidt
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
authors.forename: Johannes
authors.initials: J
authors.lastname: Beckmann
mesh_terms: D000328:Adult; D001855:Bone Marrow Diseases / Q000188:drug therapy* / Q000473:pathology; D004164:Diphosphonates / Q000627:therapeutic use*; D004487:Edema / Q000188:drug therapy* / Q000473:pathology; D011464:Epoprostenol / Q000627:therapeutic use*; D005528:Foot / Q000473:pathology; D006801:Humans; D007717:Knee / Q000473:pathology; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D013577:Syndrome; D064232:Visual Analog Scale
chemical_list: D004164:Diphosphonates; D011464:Epoprostenol