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Hip effusion/synovitis influences results after multiple drilling core decompression for bone marrow edema syndrome
Hua-Zhang Xiong1, Yan-Li Peng1, Yu-Hong Deng1
1Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, Guizhou Province, 563003, People's Republic of China.
Insights
Hip effusion/synovitis impacts outcomes for bone marrow edema syndrome of the hip (BMESH) treated with multiple drilling core decompression (MDCD). Addressing effusion/synovitis improves pain relief and healing time, offering a safe, effective treatment.
Area of Science:
- Orthopedic Surgery
- Regenerative Medicine
- Musculoskeletal Imaging
Background:
- Bone marrow edema syndrome of the hip (BMESH) is a painful condition.
- The impact of hip effusion/synovitis on the efficacy of multiple drilling core decompression (MDCD) for BMESH remains unclear.
- Assessing hip effusion/synovitis and its correlation with MDCD outcomes is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the influence of hip effusion/synovitis on the therapeutic results of MDCD in BMESH patients.
- To determine if arthroscopic management of hip effusion/synovitis enhances clinical outcomes post-MDCD.
- To investigate the safety and efficacy of combined arthroscopic treatment for BMESH with effusion/synovitis.
Main Methods:
- Retrospective review of arthroscopic-assisted MDCD for BMESH with hip effusion/synovitis (2016-2019).
- Follow-up of seven patients (9 hips) at multiple intervals (1-24 months) post-surgery.
- Assessment of pain and function using VAS, HHS, HOS-ADL, iHOT-12, and ROM, comparing pre- and post-operative data.
Main Results:
- Immediate pain relief at rest and return to pre-operative activity levels by 3 months post-surgery.
- Significant improvements in VAS, HHS, HOS-ADL, iHOT-12, and ROM at 1 month compared to pre-operative values (P < 0.05).
- Complete resolution of bone marrow edema on MRI by 3 months; no ROM limitations at final follow-up. Concomitant intra-articular pathologies identified and treated in some cases.
Conclusions:
- Hip effusion/synovitis significantly affects clinical outcomes following MDCD for BMESH.
- Arthroscopic intervention for hip effusion/synovitis shortens pain relief and edema resolution times.
- This approach is safe, allows simultaneous diagnosis and treatment of intra-articular pathologies, and leads to fewer complications.
Background:
At present, it is not known whether hip effusion/synovitis affects the therapeutic effect of multiple drilling core decompression (MDCD) in patients with bone marrow edema syndrome of hip (BMESH). The aims were to assess hip effusion/synovitis and its relationship with results of MDCD in patients with BMESH.
Methods:
The data of undergoing arthroscopic-assisted MDCD for treatment of BMESH with hip effusion/synovitis by one surgeon were retrospectively reviewed from the associated medical records at the Affiliated Hospital of Zunyi Medical University (2016-2019). Seven patients (9 hips) participated in this study. Patients were followed up at 1, 2, 3, 6, 12 and 24 months. Data included demographics and clinical outcomes. The pre- and postoperative pain and functional outcomes were measured with the visual analogue scale (VAS), Harris Hip Score (HHS), Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), International Hip Outcome Tool-12 (iHOT-12) and range of motion (ROM).
Results:
Seven patients (9 hips) were followed up. Disappearance of hip pain immediately obtained at rest after surgery. All of 7 patients returned to their former activity level at postoperative 3 months, bone marrow edema had disappeared on Magnetic Resonance Imaging (MRI). The VAS, HHS, HOS-ADL, iHOT-12, and ROM at postoperative 1 month had a significant difference (P < 0.05) compared with preoperative. It was also statistically significant (P < 0.05) when compared with other time points. At the final follow-up, all patients had no limited ROM, which was symmetrical with the contralateral of hip joint. Hip effusion/synovitis were observed in 9 hips. Labral tears, cartilage fissure, and loose bodies were observed in 1 hip, respectively. Kirschner wire tracks bleeding occurred in 1 hip. No other complications occurred.
Conclusions:
Hip effusion/synovitis could affect the clinical outcomes after MDCD in patients with BMESH. Arthroscopic procedure of hip effusion/synovitis can shorten postoperative pain relief time, disappearance time of bone marrow edema on MRI. It can simultaneously diagnose and treat other concomitant intraarticular pathologies, and be a safe operation with fewer complications.
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