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. 2025 Oct 10;145(1):462.
doi: 10.1007/s00402-025-06057-7.

Iloprost therapy achieves good clinical and radiological short and mid-term outcomes in patients with idiopathic aseptic osteonecrosis of the knee joint also in ARCO level II

Stephanie Kirschbaum  1 , Carsten Perka  2 , Moses El-Kayali  2 , Clemens Gwinner  2 , Thula Cannon Walter-Rittel  3 , Maurice Soujon  2 , Stefanie Donner  2
Affiliations

Iloprost therapy achieves good clinical and radiological short and mid-term outcomes in patients with idiopathic aseptic osteonecrosis of the knee joint also in ARCO level II

Stephanie Kirschbaum et al. Arch Orthop Trauma Surg. .

Abstract

Aims: The aim of this retrospective study was the evaluation of the patient-reported and radiological outcome of intravenous Iloprost therapy in the treatment of spontaneous osteonecrosis of the knee (SONK).

Methods: 36 patients (age 57.3 ± 8.7 years, 38.9% women, 61.1% men) who received Iloprost between 2018 and 2021 due to SONK (ARCO I and II) were included in this retrospective cohort study. Outcome was evaluated by pre- and postinterventional pain (Numeric Rating Scale - NRS), patient reported outcome (subjective knee value (SKV), Oxford Knee Score (OKS)) at latest follow-up (2.9 months ± 1) as well as quantitative artificial intelligence assisted analysis of bone marrow edema (BME) in Magnetic Resonance Imaging (MRI) before and after 3 months.

Results: Radiologically, there was a 71% reduction in edema (pre-intervention: 37.0 cm³±37.7, post-intervention: 10.8 cm³ ± 14.9, p < 0.01). Overall satisfaction was 2.0 ± 1.3, SKV was 83.3%±16.6 and NRS at follow-up was 1.3 ± 1.8. OKS reached 33.6 ± 12.0. No major complications were observed. Rare side effects were dizziness which required premature termination of Ilomedin therapy on day 3.

Conclusion: Iloprost treatment seems a safe and promising therapeutic option also in SONK with excellent subjective outcome and reduction of BME of 70% within 3 months after Iloprost infusion.

Keywords: Aseptic osteonecrosis; Bone marrow oedema; Iloprost; SONK.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The retrospective study design was approved by the local ethics board (EA4/251/21). Patient consent: Written consent was obtained from every study participant.

Figures

Fig. 1
Fig. 1
Iloprost therapy plan
Fig. 2
Fig. 2
patients’ enrolment
Fig. 3
Fig. 3
(a) of region of interest (ROI) of observer 1 in pre-treatment MRI (PD fs, coronal slicing, 3 mm thickness), (b) ROI of observer 1 in 3 months post treatment MRI (PD fs, coronal slicing, 3 mm thickness)
Fig. 4
Fig. 4
(a) of region of interest (ROI) of reader 1 in pre-treatment MRI (PD fs, coronal slicing, 3 mm thickness); (b) comparison of ROI delineation between observer 1 and 2, which used different threshold signal intensities to determine delineation
Fig. 5
Fig. 5
3D volume for segmented ROIs for reader 1 (green delineation, green ROI) and reader 2 (blue delineation, blue ROI)
Fig. 6
Fig. 6
Distribution of satisfaction after Iloprost therapy at latest follow-up according to German school grading system (1-excellent, 6- failed)
Fig. 7
Fig. 7
Volume of hyperintense area in MRI before and after Iloprost therapy showed significant reduction (p < 0.001)
See this image and copyright information in PMC

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