scholarly journals Proposal of early retreatment with iloprost in partially responsive patients with bone marrow edema syndrome: a case report

2012 ◽  
Author(s):  
Simone Meini ◽  
Grazia Panigada
Keyword(s):  
Bone Marrow ◽  
Case Report ◽  
Surgical Procedures ◽  
Bone Marrow Edema ◽  
Bone Destruction ◽  
Core Decompression ◽  
Harris Hip Score ◽  
Single Cycle ◽  
Advanced Stages ◽  
Magnetic Resonance Imaging Mri

Background Avascular Necrosis (AVN) is defined as the cellular death of bone components due to an alteration of the blood supply, resulting in Edema of the Bone Marrow (BME), structural collapse and bone destruction. In advanced stages, AVN requires surgery. One emerging medical treatment for supporting osseous perfusion is the administration of iloprost.Materials and methods A 38-year-old woman presented with severe BME of the left hip (primary), persisting for 6 weeks. She was treated with iloprost iv at 2 ng/kg/min for 6 hours/day for 5 days, and after 4 weeks, the treatment was repeated at 1.5 ng/kg/min for 6 hours for 5 days because she exhibited only a partial response to the first treatment. Complete remission was obtained, documented clinically and on Magnetic Resonance Imaging (MRI). Her Harris Hip Score (HHS) increased from 29.90 to 97. No significant adverse events related to iloprost were registered. No surgical procedures were necessary.Conclusions In most cases, iloprost is administered in a single cycle of treatment over 5 days at 1-2 ng/kg/min for 6 hours/day, but no research has investigated the effectiveness of early retreatment after the first cycle results in only a partially response. Only a few studies examining small numbers of patients have evaluated iloprost in AVN/BME, preferring, in most cases, the dose of 1 ng/kg/min and obtaining clinical improvement both in BME and in AVN in times comparable to surgical core decompression. This case report demonstrates the safety and effectiveness of early repetition of the maximal dose of iloprost before BME evolves into AVN, as well as in cases initially appearing serious and requiring surgical procedures.

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

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Tim Claßen ◽  
Antonia Becker ◽  
Stefan Landgraeber ◽  
Marcel Haversath ◽  
Xinning Li ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Total Joint Replacement ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Avascular Osteonecrosis ◽  
Surgical Methods ◽  
Advanced Stages ◽  
Subjective Complaints ◽  
Marrow Edema

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.

Hip Arthroscopic Management Can Improve Osteitis Pubis and Bone Marrow Edema in Competitive Soccer Players With Femoroacetabular Impingement

2019 ◽  
Vol 47 (2) ◽  
pp. 408-419 ◽  
Author(s):  
Masayoshi Saito ◽  
Hajime Utsunomiya ◽  
Akihisa Hatakeyama ◽  
Hirotaka Nakashima ◽  
Haruki Nishimura ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Femoroacetabular Impingement ◽  
Bone Marrow Edema ◽  
Soccer Players ◽  
Harris Hip Score ◽  
Osteitis Pubis ◽  
Arthroscopic Management ◽  
Modified Harris Hip Score ◽  
Marrow Edema

Background: There is a dearth of knowledge regarding the correlation between femoroacetabular impingement (FAI) and osteitis pubis (OP) among symptomatic soccer players. Purpose: To elucidate whether arthroscopic FAI correction is effective for young competitive soccer players with FAI combined with OP or perisymphyseal pubic bone marrow edema (BME). Study Design: Case series; Level of evidence, 4. Methods: A total of 577 consecutive patients who underwent arthroscopic FAI correction were retrospectively reviewed with a minimum 2-year follow-up. Competitive soccer players who were professional, college, and high school athletes were included. The authors assessed the modified Harris Hip Score and Nonarthritic Hip Score preoperatively and at 6 months, 1 year, and 2 years after surgery. In addition, players were divided into groups according to radiographic evidence of OP and BME (2 groups each). Clinical outcomes, return to play, and radiographic assessments were compared between groups. Results: Twenty-eight hips met the inclusion criteria. The median modified Harris Hip Score significantly improved after hip arthroscopy (81.4, preoperatively; 95.7 at 6 months, P = .0065; 100 at 1 year, P = .0098; 100 at 2 years, P = .013). The median Nonarthritic Hip Score also significantly improved (75.0, preoperatively; 96.3 at 6 months, P = .015; 98.8 at 1 year, P = .0029; 100 at 2 years, P = .015). Furthermore, 92.0% of players returned to play soccer at the same or higher level of competition at a median 5.5 months (range, 4-15 months); 67.8% had radiological confirmation of OP; and 35.7% had pubic BME. The alpha angle was significantly higher in pubic BME group than the no–pubic BME group (64.8° vs 59.2°, P = .027), although there was no significant difference between the OP and no-OP groups. The prevalence of tenderness of the pubic symphysis significantly decreased preoperatively (32.1%) to postoperatively (3.6%). Magnetic resonance imaging findings confirmed that pubic BME disappeared in all players at a median 11 months (range, 6-36) after initial surgery. Conclusions: Arthroscopic management for FAI provides favorable clinical outcomes, a high rate of return to sports, and, when present, resolution of pubic BME among competitive soccer players.

Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee

2008 ◽  
Vol 49 (9) ◽  
pp. 1031-1037 ◽  
Author(s):  
M. H. Brem ◽  
P. M. Schlechtweg ◽  
J. Bhagwat ◽  
M. Genovese ◽  
M. F. Dillingham ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Spin Echo ◽  
Time Correlation ◽  
Fast Spin Echo ◽  
Osteoarthritis Of The Knee ◽  
Point Image ◽  
Magnetic Resonance Imaging Mri ◽  
Marrow Edema ◽  
Over Time

Background: Bone marrow edema (BME) is a condition detectable with magnetic resonance imaging (MRI) and is present in different stages of osteoarthritis (OA). Its pathogenesis is still not completely known. Purpose: To evaluate the longitudinal occurrence and persistence of BME in early OA of the knee. Material and Methods: Twenty-three patients (eight females, 15 males; mean age 55.5±10.3 years) were scanned with a 1.5T MR imaging unit (sagittal fat-suppressed intermediate-weighted fast spin echo; 4-mm section thickness, 1-mm intersection gap, 256x192 matrix, 120-mm field of view). Images were obtained in all 23 patients at two time points (TPs) and in 12 patients at three TPs. Images were evaluated by two readers independently; discrepancies in image grading were reviewed and evaluated in consensus. A four-point image-grading scale was used (absence of BME to severe BME). Four main anatomical regions were evaluated (medial femur, lateral femur, medial tibia, lateral tibia), which were subcategorized into anterior, central, and posterior regions. Results: One hundred five areas of BME in the 23 patients were found at all three TPs. In 16 areas, the BME was consistent at the same location over time, in seven locations the BME became larger, in six areas the BME became smaller, and in 16 locations it could not be detected in follow-up MRIs. In one case, the BME was smaller at TP2 but increased at TP3. In eight cases, only at the last time point could a BME be detected. Conclusion: BME is not a static phenomenon but changes over time. Correlation to physical activity and local inflammatory reaction should be evaluated.

scholarly journals Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Shibing Xu ◽  
Lei Zhang ◽  
Hongting Jin ◽  
Letian Shan ◽  
Li Zhou ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Bone Marrow Stem Cells ◽  
Harris Hip Score ◽  
Autologous Bone

Objective. This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Methods. Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. The data analysis was performed by using the RevMan version 5.3. Results. A total of 11 studies with 507 participants were included. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. In the subgroup analysis, the results did not change in different intervention measure substantially. In addition, the safety of CDBMSCs for ANFH is reliable. Conclusion. Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH.

scholarly journals Letter to Editor - A Clinical ‘PIC- Perspectives, issues & Concerns” on Idiopathic Transient Osteoporosis during Pregnancy with alarm bells on its Idiopathic nature - Response

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sharat Agarwal
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Transient Osteoporosis ◽  
Bone Marrow Edema Syndrome ◽  
Labral Tears ◽  
Transient Bone Marrow Edema ◽  
Bone Marrow Edema Pattern ◽  
Magnetic Resonance Imaging Mri ◽  
Articular Pathology ◽  
Marrow Edema

Dear Editor, At the outset, I would like to congratulate the authors of the article published in your journal in the current issue entitled- Idiopathic Transient Osteoporosis during Pregnancy – Report of a Clinical Case JOCR November – December 2019 Volume 9 Issue 6 Page 54-57. However, I regret to mention that the workup mentioned in this article needs to be improved, before one can come to definitive diagnosis of Idiopathic Transient Osteoporosis during Pregnancy. I would like to highlight various perspectives, issues & concerns, the knowledge of which are must for the readers of this journal pertaining to this disorder. It is pertinent to mention no doubt the increasing utilization of magnetic resonance imaging (MRI) has allowed physicians to investigate edematous changes in bone marrow, a clinically important entity which was previously undetected on conventional radiographs. The first use of the term “bone marrow edema” was by Wilson et al in 1988, and the term “bone marrow edema syndrome” was described in 1993 after the investigation of histological specimens [1]. Later on, importantly Hayes et al. advocated that the term “transient bone marrow edema syndrome” should be used for patients in whom the bone marrow edema pattern was not accompanied by radiographic evidence of osteopenia [2]. And thus separating the two entities i.e. “the transient bone marrow edema syndrome” and “Transient Osteoporosis” Occurrence of hip pain during pregnancy is quite common, although transient osteoporosis as a condition causing this symptom is uncommonly seen. Clinicians should also be aware of intra-articular disorders such as loose bodies, and labral tears; peri-articular pathology such as tendinitis and bursitis; or extra-articular conditions such as referred pain from the lumbar spine, the sacroiliac joint, and or from nerve entrapment syndromes. So, a detailed history and physical examination is helpful to narrow the differential diagnoses, which, in turn, dictate the modal

scholarly journals Porous tantalum implant for treatment of early-stage osteonecrosis of the femoral head: a minimum 5-year follow-up study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Zhang ◽  
Wang Chen ◽  
Zhi Yang ◽  
Jian-Ning Sun ◽  
Zheng-Hao Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Femoral Head ◽  
Bone Marrow Edema ◽  
Operation Time ◽  
Harris Hip Score ◽  
Porous Tantalum ◽  
Imaging Results ◽  
Marrow Edema

Abstract Background To evaluate the survival rate of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head (ONFH), evaluate its clinical effect and imaging results. Methods From January 2008 to December 2013, porous tantalum rod implantation for ONFH was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion were recorded. Results 52 hips received complete follow-up, the average follow-up time was 85.7 months (60–132 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was 44.3 ± 32.8 months, and the average Harris hip score before THA was 57.1 ± 7.6. Cox proportional-hazards model revealed that Association Research Circulation Osseous (ARCO) stage (P = 0.017), bone marrow edema (P = 0.006) and age > 40 years (P = 0.043) were independent risk factors for conversion to THA. Conclusion ARCO stage, age and bone marrow edema were risk factors for the failure of porous tantalum rod implantation to convert to THA.

scholarly journals TRANSIENT HIP BONE MARROW EDEMA SYNDROME - A CASE REPORT

2021 ◽  
Author(s):  
Alisson Regis de Santana ◽  
Mittermayer Barreto Santiago
Keyword(s):  
Bone Marrow ◽  
Case Report ◽  
Bone Marrow Edema ◽  
Bone Marrow Edema Syndrome ◽  
Marrow Edema

Cone beam-navigated core decompression of bone marrow edema syndrome

2020 ◽  
Vol 140 (11) ◽  
pp. 1603-1609 ◽  
Author(s):  
Timo Zippelius ◽  
Patrick Strube ◽  
Georg Matziolis ◽  
Eric Röhner ◽  
Sabrina Böhle ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Core Decompression ◽  
Cone Beam ◽  
Bone Marrow Edema Syndrome ◽  
Marrow Edema
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