BONE MARROW OEDEMA SYNDROME OF THE FEMORAL HEAD: COMPARISON OF THERAPY WITH THE PROSTACYCLINE-ANALOGUE ILOPROST AND CORE DECOMPRESSION
Landsiedl F. 1, Aigner N. 1, Schneider W. 2, Petje G. 3, Krasny C. 1, Meizer R. 1, Knahr K. 2Orthopaedic Hospital Vienna Speising, Speisingerstr. 109, A - 1130 Vienna, Austria

The aim of the study was to evaluate the effect of the vasoactive prostacycline analogue Iloprost in comparison to core decompression in the therapy of bone marrow oedema syndrome (BMOS) of the hip. This substance dilates arterioles and venoles and reduces capillary permeability.

We report about 36 patients (38 hips) with BMOS. In group 1 with 17 patients (18 hips) with a mean age of 49 years were treated iloprost. Therapy consisted in a series of 5 infusions with 20mcrg Iloprost over 6 hours on 5 consecutive days. In group 2 19 patients (20 hips) a core decompression of the femoral head was performed followed by 6 weeks of partial weight bearing. Both groups were examined clinically according to Harris Hip Score (HHS). Before and three months after therapy a MRI was performed.

In group 1 a patient had to discontinue therapy. In the remaining patients HHS improved from 64,7 points (44-89) before therapy to 96,8 points (83-100) after a mean follow-up period of 11 months. MRI-controls after 3 months showed a complete remission in all hips. In group 2 preoperative HHS improved from 53,7 points (31-82) to 95,1 points (39-100) after a mean follow-up period of 12 months. MRI showed a complete remission in 14 hips, a remaining focal bone marrow oedema in 4 hips and small osteonecrotic areas in 2 hips.