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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 543-550
DOI: 10.1016/j.rboe.2017.12.008
Artigo Original
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Effect of Zoledronic Acid and Alendronate on Bone Edema and Pain in Spontaneous Osteonecrosis of the Knee: A New Paradigm in the Medical Management[*]

Article in several languages: português | English
Sanjay Agarwala 
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
,
Lokesh Sharoff
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
,
Naeem Jagani
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
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Abstract

Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment.

Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks.

Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p = 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p = 0.03).

Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.

Keywords

necrosis - bisphosphonates - osteoarthritis - knee joint

* Study conducted at the Hinduja Hospital and Medical Research Centre, Mumbai, India. Published Originally by Elsevier Editora Ltda.




Publication History

Received: 30 July 2017

Accepted: 07 December 2017

Article published online:
19 December 2019

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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