Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

Abstract

Background:Bone marrow edema (BME) is a common cause of hip pain. The aim of the study was to assess the efficacy of the vasoactive drug iloprost in the treatment of BME of femoral head.Materials and Methods:We reviewed 27 patients (19 male, 8 female) with BME of the femoral head. Their mean age was 53.7 ± 10.8 years. All patients 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 to 50 μg iloprost over 6 h on 5 consecutive days each. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. Pain at rest as well as under stress was assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy.Results:At the clinical follow up of four months after therapy, the pain level at rest had diminished by a mean of 58.3% (P < 0.0001). Pain under stress decreased by a mean of 41.9% (P < 0.0001). On MRI, 20 patients had a significant reduction of BME size or complete normalization and 4 showed no change. Worsening of the MRI pattern was found in 3 patients.Conclusion:The authors conclude that the use of parenteral iloprost might be a viable method in the treatment of BME of femoral head.