Efficiency of Iloprost Treatment for Osseous Malperfusion

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2010 Mar 23

PMID 20306261

Citations 20

Authors

Marcus Jager

Christoph Zilkens

Bernd Bittersohl

Travis Matheney

Gordana Kozina

Dirk Blondin

Rudiger Krauspe

Affiliations

Soon will be listed here.

Abstract

Insufficient osseous blood supply results in bone marrow oedema (BMO) and/or avascular necrosis (AVN). One treatment option to support osseous perfusion is the application of stable prostacycline analog iloprost. In this clinical study, 95 patients were treated with iloprost for BMO/AVN. One hundred eighty-six bones were affected by BMO/AVN before treatment. Average follow-up was 33.0 ± 17.6 months. Pain levels could be reduced (e.g. visual analogue scale, 5.0 ± 2.2 points reduced to 1.7 ± 2.2 points) and functional scores improved (Harris hip score, 52 ± 21 points to 79 ± 17 points) in the course of treatment. According to current data, healing of advanced stages of osteonecrosis is not possible. However, the results of this case series confirm previous findings that in early stages of insufficient osseous blood flow iloprost can contribute to the relief of pain and improve joint function.

Citing Articles

Techniques of core decompression in the treatment of idiopathic avascular necrosis of the femoral head.

Dube M, Emara A, Deren M, Pasqualini I, Rullan P, Tidd J Arch Orthop Trauma Surg. 2024; 145(1):82.

PMID: 39708161 DOI: 10.1007/s00402-024-05732-5.

A Current Review in the Orthopedic Management of Osteonecrosis of the knee Secondary to Treatment of Pediatric Hematologic Malignancy.

Gottlich C, Fisher J, Diab M Orthop Rev (Pavia). 2024; 16:115354.

PMID: 38533522 PMC: 10963255. DOI: 10.52965/001c.115354.

Comparison of two joint-preserving treatments for osteonecrosis of the femoral head: core decompression and core decompression with additional cancellous bone grafting.

Woerner M, Voelkl K, Bliemel C, Ferner F, Weber M, Renkawitz T J Int Med Res. 2023; 51(8):3000605231190453.

PMID: 37585739 PMC: 10416661. DOI: 10.1177/03000605231190453.

The Use of Iloprost in the Treatment of Bone Marrow Edema Syndrome of the Proximal Femur: A Review and Meta-Analysis.

Zippelius T, Strube P, Rohe S, Schlattmann P, Dobrindt O, Caffard T J Pers Med. 2022; 12(11).

PMID: 36573724 PMC: 9695808. DOI: 10.3390/jpm12111757.

The additive effect of iloprost on the biological properties of Mineral trioxide aggregate on mesenchymal stem cells.

Almeshari A, Elsafadi M, Almadhari R, Mahmood A, Alsubait S, Aksel H J Dent Sci. 2022; 17(1):225-232.

PMID: 35028042 PMC: 8739256. DOI: 10.1016/j.jds.2021.03.018.

References

Tillmann F, Jager M, Blondin D, Schooldermann D, Voiculescu A, Sucker C . Intravenous iloprost: a new therapeutic option for patients with post-transplant distal limb syndrome (PTDLS). Am J Transplant. 2007; 7(3):667-71. DOI: 10.1111/j.1600-6143.2007.01662.x. View

Hernigou P, Beaujean F . Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002; (405):14-23. DOI: 10.1097/00003086-200212000-00003. View

Trancik T, Lunceford E, Strum D . The effect of electrical stimulation on osteonecrosis of the femoral head. Clin Orthop Relat Res. 1990; (256):120-4. View

Jager M, Werner A, Lentrodt S, Modder U, Krauspe R . [Pain management in non-juvenile, aseptic osteonecrosis]. Schmerz. 2004; 18(6):481-91. DOI: 10.1007/s00482-004-0356-9. View

Schmitt-Sody M, Kirchhoff C, Mayer W, Goebel M, Jansson V . Avascular necrosis of the femoral head: inter- and intraobserver variations of Ficat and ARCO classifications. Int Orthop. 2007; 32(3):283-7. PMC: 2323428. DOI: 10.1007/s00264-007-0320-2. View

Disch A, Matziolis G, Perka C . The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br. 2005; 87(4):560-4. DOI: 10.1302/0301-620X.87B4.15658. View

Aigner N, Petje G, Schneider W, Krasny C, Grill F, Landsiedl F . Juvenile bone-marrow oedema of the acetabulum treated by iloprost. J Bone Joint Surg Br. 2002; 84(7):1050-2. DOI: 10.1302/0301-620x.84b7.13175. View

Jager M, Tillmann F, Thornhill T, Mahmoudi M, Blondin D, Hetzel G . Rationale for prostaglandin I2 in bone marrow oedema--from theory to application. Arthritis Res Ther. 2008; 10(5):R120. PMC: 2592809. DOI: 10.1186/ar2526. View

Aigner N, Meizer R, Stolz G, Petje G, Krasny C, Landsiedl F . Iloprost for the treatment of bone marrow edema in the hindfoot. Foot Ankle Clin. 2004; 8(4):683-93. DOI: 10.1016/s1083-7515(03)00145-1. View

10.

Aigner N, Petje G, Schneider W, Meizer R, Wlk M, Kotsaris S . Bone marrow edema syndrome of the femoral head: treatment with the prostacyclin analogue iloprost vs. core decompression: an MRI-controlled study. Wien Klin Wochenschr. 2005; 117(4):130-5. DOI: 10.1007/s00508-005-321-3. View

11.

Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H . Does alendronate prevent collapse in osteonecrosis of the femoral head?. Clin Orthop Relat Res. 2006; 443:273-9. DOI: 10.1097/01.blo.0000194078.32776.31. View

12.

Werner A, Jager M, Schmitz H, Krauspe R . Joint preserving surgery for osteonecrosis and osteochondral defects after chemotherapy in childhood. Klin Padiatr. 2003; 215(6):332-7. DOI: 10.1055/s-2003-45495. View

13.

Disch A, Matziolis G, Reinke P, Perka C . Intravenous Iloprost treatment for severe bone pain caused by sickle cell crisis. Thromb Haemost. 2004; 91(5):1047-9. View

14.

Jager M, Zilkens C, Westhoff B, Jelinek E, Kozina G, Krauspe R . Efficiency of iloprost treatment for chemotherapy-associated osteonecrosis after childhood cancer. Anticancer Res. 2009; 29(8):3433-40. View

15.

STEINBERG M . Osteonecrosis of the hip: summary and conclusions. Semin Arthroplasty. 1991; 2(3):241-9. View

16.

Glueck C, Freiberg R, Sieve L, Wang P . Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop Relat Res. 2005; (435):164-70. DOI: 10.1097/01.blo.0000157539.67567.03. View

17.

Mitchell D, Rao V, Dalinka M, Spritzer C, Alavi A, STEINBERG M . Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 1987; 162(3):709-15. DOI: 10.1148/radiology.162.3.3809484. View

18.

Grant S, Goa K . Iloprost. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in peripheral vascular disease, myocardial ischaemia and extracorporeal circulation procedures. Drugs. 1992; 43(6):889-924. DOI: 10.2165/00003495-199243060-00008. View

19.

Meizer R, Radda C, Stolz G, Kotsaris S, Petje G, Krasny C . MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost. Wien Klin Wochenschr. 2005; 117(7-8):278-86. DOI: 10.1007/s00508-005-0326-y. View

20.

Bernbeck B, Christaras A, Krauth K, Lentrodt S, Strelow H, Schaper J . Bone marrow oedema and aseptic osteonecrosis in children and adolescents with acute lymphoblastic leukaemia or non-Hodgkin-lymphoma treated with hyperbaric-oxygen-therapy (HBO): an approach to cure? -- BME/AON and hyperbaric oxygen therapy as a.... Klin Padiatr. 2004; 216(6):370-8. DOI: 10.1055/s-2004-832341. View