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The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost

Department of Orthopaedic Surgery, Centre of Musculoskeletal Surgery, Charité-University Medicine, Schumannstrasse 20/21, 10117 Berlin, Germany.

Correspondence should be sent to Dr A. C. Disch; e-mail: alexander.disch{at}charite.de

Bone-marrow oedema can occur both in isolation and in association with necrosis of bone, but it has not been shown whether each respond to the same methods of treatment.

We treated 16 patients with isolated oedema and 17, in which it was associated with necrosis of the proximal femur, with the prostacyclin derivative iloprost, which has been shown to be effective in the idiopathic form. The Harris hip score, the range of movement, the extent of the oedema as measured by MRI, pain on a visual analogue scale and patient satisfaction were recorded before and subsequent to treatment.

In both groups, we were able to show a significant improvement (p < 0.001) in these observations during the period of follow-up indicating that iloprost will produce clinical improvement in both circumstances.