Efficiency of iloprost treatment for osseous malperfusion.

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.

Efficiency of iloprost treatment for chemotherapy-associated osteonecrosis after childhood cancer.

BACKGROUND: The risk of developing avascular osteonecrosis (AVN) after chemotherapy is age related and, at up to 17% of all treated patients, relatively high. PATIENTS AND METHODS: In a prospective study, 8 patients (4 male, 4 female, 14.3+/-4.9 years old) were treated for symptomatic chemotherapy-associated AVN with intravenous infusion of iloprost. Association Research Circulation Osseus (ARCO) stages I-IV in 37 bones (25 joints) were treated. RESULTS: Follow-up was 20.8+/-17 months (range: 6-53 months). No serious adverse reactions due to the infusion with iloprost were recorded. Pain levels were lower and functional outcome measured as Harris Hip and Knee Society Scores improved by the latest follow up. CONCLUSION: Our current data confirm the findings of other investigators that healing of advanced stages of AVN is not possible, but that in early stages of AVN, pain relief and an improvement of joint function can be achieved by iloprost.