Management of Bone Marrow Lesions of the Hip With Subchondral Calcium Phosphate Injection: Surgical Technique and Tips

Abstract Background Chronic bone marrow lesions (BML) in the weight-bearing portions of the knee are often associated with symptomatic degenerative arthritis resulting in pain and dysfunction. Injection of bone substitute material like calcium phosphate has been described. Whilst some studies have reported encouraging results others have shown limited benefit of this technique. Aim The aim was to collate the available evidence on the injection of calcium phosphate and systematically evaluate the results to answer the questions encountered in clinical decision making: (1) does it provide effective long-lasting pain relief to avoid further surgical intervention? (2) which factors (patient/surgical) significantly influence the outcome? and (3) does it adversely affect the outcomes of subsequent arthroplasty? Methods A literature search was performed to identify the studies describing the clinical outcomes of calcium phosphate injection for treatment of BML. We evaluated the reported clinical outcomes with respect to pain, function and complications. Isolated case reports and studies with no objective assessment of clinical outcomes were excluded. Results We noted 46 articles in the current literature of which 8 described clinical outcomes of calcium phosphate injection. Mean (plus/minus SD) score on the visual analog scale (VAS) has been reported to improve from 7.90 (± 0.38) to 2.76 (± 0.90), whereas the International Knee Documentation Committee (IKDC) score improved from 30.5 (SD not reported (NR)) to 53.0 (SD NR). Pre and post procedure Short form survey (SF-12) scores were 29.8 (SD NR) and 36.7 (SD NR), respectively. In one study, scores on the Tegner Lysholm knee scoring scale improved in 12 out of 22 patients, whereas the remainder had no change in symptoms. Extravasation of calcium phosphate into the joint was the most common complication, whereas no adverse effect has been reported on subsequent arthroplasty. Conclusion Limited data from the published studies would suggest that calcium phosphate injection of BML may potentially improve pain and function. However, no evidence is currently available to clearly identify patient/surgical factors that may influence the long-term outcomes of this procedure. Hence pragmatic, prospective studies with stratified patient cohorts and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of this novel procedure.

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Evaluation and Management of Subchondral Calcium Phosphate Injection Technique to Treat Bone Marrow Lesion

Cartilage ◽

10.1177/1947603518770249 ◽

2018 ◽

Vol 10 (4) ◽

pp. 395-401 ◽

Cited By ~ 7

Author(s):

Diego Costa Astur ◽

Eduardo Vasconcelos de Freitas ◽

Pedro Barreira Cabral ◽

Caio Carvalho Morais ◽

Bruno Silveira Pavei ◽

...

Keyword(s):

Bone Marrow ◽

Calcium Phosphate ◽

Femoral Condyle ◽

Bone Marrow Lesion ◽

Functional Improvement ◽

Injection Technique ◽

Pain Complaint ◽

Total Knee ◽

Phosphate Injection ◽

Phosphate Treatment

Purpose This study aimed to compile available data in medical literature about subchondral calcium phosphate injection, comparing results obtained with this technique, as well as indications, complications, and other important factors in treatment of bone marrow lesions. Designs A literature review using PubMed and Medline database in order to identify works with terms “subchondral calcium phosphate injection,” “ subchondroplasty®,” “bone marrow lesion,” and “knee.” Eight relevant articles were found. Results A total of 164 patients with bone marrow lesion mainly on femoral condyle and tibial plateau recovered with significant functional improvement of knee after subchondral calcium phosphate treatment. Although 25% of them still had some type of pain complaint, they also showed improvement. There were few complications reported and return to activities occurred after 3 months on average. Conclusions Few studies evaluate the result of using subchondral calcium phosphate injection technique. However, all presented favorable results regarding pain and improvement of knee function. In addition, within 2 years, there was a 70% reduction in conversion to total knee arthroplasty in patients with previous surgical indication who choose calcium phosphate treatment.

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