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

  • Tim Claßen | timclassen@gmx.de Department of Orthopedics, University of Duisburg-Essen, Essen, Germany.
  • Antonia Becker Department of Orthopedics, University of Duisburg-Essen, Essen, Germany.
  • Stefan Landgraeber Department of Orthopedics, University of Duisburg-Essen, Essen, Germany.
  • Marcel Haversath Department of Orthopedics, University of Duisburg-Essen, Essen, Germany.
  • Xinning Li Department of Orthopedic Surgery, Boston University School of Medicine, Sports Medicine and Shoulder Surgery, Boston, MA, United States.
  • Christoph Zilkens Department of Orthopedics, Heinrich-Heine University, Düsseldorf, Germany.
  • Rüdiger Krauspe Department of Orthopedics, Heinrich-Heine University, Düsseldorf, Germany.
  • Marcus Jäger Department of Orthopedics, University of Duisburg-Essen, Essen, Germany.

Abstract

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.

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Published
2016-03-31
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Original Articles
Keywords:
Avascular osteonecrosis, iloprost, bone marrow edema
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How to Cite
Claßen, T., Becker, A., Landgraeber, S., Haversath, M., Li, X., Zilkens, C., Krauspe, R., & Jäger, M. (2016). Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis. Orthopedic Reviews, 8(1). https://doi.org/10.4081/or.2016.6150