The role of core decompression in management of bone marrow oedema syndrome of the hip

الملخص EN

Purpose: To determine effectiveness of early diagnosis of bone marrow oedema syndrome of the hip by magnetic resonance imaging (MRI) with early surgical core decompression before occurance of avascular necrosis of the femoral head.

Methods: 12 Symptomatic painful hips in 9 mal؟ patients aged 36-52 years with a mean age of 40.3 years.

٨١١ patients have not metabolic, neoplastic or inflammatory disorders and none had previous history of trauma or steroid therapy.

All patients were diagnosed by magnetic resonance imaging (MRI).

Core decompression was done using terephines .

8-10mm in 7 hips.

In one patient; the contralateral hip had been managed conservatively by analgesics nonsteroidal drugs with physiotherapy one year prior to surgical treatment.

The 5 remaining affected joints were managed conservatively with protected weight bearing and ' nonsteroidal anti،inflammatory medication with physiotherapy.

Histological study was done for 4 cases from the material and all are confirmed to be bone marrow oedema.

Results: Nine cases had pain with hip movement before decompression operation.

Six cases had complete relief of pain and restoration of a normal range of movement within one month of the surgery.

The mean duration of pain was significantly shorter after decompression than it was after non- operative management by nonsteriodal medication and physiotherapy.

There were no post operative complications.

MRT scans performed three months after surgery showed the core tracks with complete resolution of the effusion and marrow changes.

The bone volume intensity was normal with no evidence of osteoporosis.

Conclusions: This study suggested that bone marrow oedema sydrome may be an early reversible form of avascular necrosis of the femoral head and bas^d on this concept and because the course of the condition may be as long as 45 months, core decompression has been advised.

The clinical results of core decompression has been excellent.

It is a simple operation that can be performed and shortens the duration of symptoms and decrease the possibility of progression to avascular necrosis