Talar Avascular Necrosis After Calcium Phosphate Injection Treatment of Talar Bone Marrow Lesions

2020 ◽  
Vol 10 (2) ◽  
pp. e19.00389-e19.00389
Author(s):  
Jessica M. Kohring ◽  
Irvin Oh ◽  
Judith F. Baumhauer
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Avascular Necrosis ◽  
Bone Marrow Lesions ◽  
Injection Treatment ◽  
Phosphate Injection

scholarly journals Calcium phosphate injection of symptomatic bone marrow lesions of the knee: what is the current clinical evidence?

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
D. S. Angadi ◽  
D. Edwards ◽  
J. T. K. Melton
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Short Form ◽  
Case Reports ◽  
Objective Assessment ◽  
Weight Bearing ◽  
Bone Marrow Lesions ◽  
Phosphate Injection

Abstract Background Chronic bone marrow lesions (BML) in the weight-bearing portions of the knee are often associated with symptomatic degenerative arthritis resulting in pain and dysfunction. Injection of bone substitute material like calcium phosphate has been described. Whilst some studies have reported encouraging results others have shown limited benefit of this technique. Aim The aim was to collate the available evidence on the injection of calcium phosphate and systematically evaluate the results to answer the questions encountered in clinical decision making: (1) does it provide effective long-lasting pain relief to avoid further surgical intervention? (2) which factors (patient/surgical) significantly influence the outcome? and (3) does it adversely affect the outcomes of subsequent arthroplasty? Methods A literature search was performed to identify the studies describing the clinical outcomes of calcium phosphate injection for treatment of BML. We evaluated the reported clinical outcomes with respect to pain, function and complications. Isolated case reports and studies with no objective assessment of clinical outcomes were excluded. Results We noted 46 articles in the current literature of which 8 described clinical outcomes of calcium phosphate injection. Mean (plus/minus SD) score on the visual analog scale (VAS) has been reported to improve from 7.90 (± 0.38) to 2.76 (± 0.90), whereas the International Knee Documentation Committee (IKDC) score improved from 30.5 (SD not reported (NR)) to 53.0 (SD NR). Pre and post procedure Short form survey (SF-12) scores were 29.8 (SD NR) and 36.7 (SD NR), respectively. In one study, scores on the Tegner Lysholm knee scoring scale improved in 12 out of 22 patients, whereas the remainder had no change in symptoms. Extravasation of calcium phosphate into the joint was the most common complication, whereas no adverse effect has been reported on subsequent arthroplasty. Conclusion Limited data from the published studies would suggest that calcium phosphate injection of BML may potentially improve pain and function. However, no evidence is currently available to clearly identify patient/surgical factors that may influence the long-term outcomes of this procedure. Hence pragmatic, prospective studies with stratified patient cohorts and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of this novel procedure.

scholarly journals Outcomes following Subchondroplasty in the First Metatarsal Head

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0043
Author(s):  
Akhil Sharma ◽  
Craig C. Akoh ◽  
Selene G. Parekh
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Avascular Necrosis ◽  
Early Stage ◽  
Metatarsal Head ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Exclusion Criteria ◽  
First Metatarsal ◽  
Vas Scores

Category: Midfoot/Forefoot; Other Introduction/Purpose: Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery. Methods: A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data. Results: In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition. Conclusion: Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.

scholarly journals Evaluation and Management of Subchondral Calcium Phosphate Injection Technique to Treat Bone Marrow Lesion

Cartilage ◽  
2018 ◽  
Vol 10 (4) ◽  
pp. 395-401 ◽  
Author(s):  
Diego Costa Astur ◽  
Eduardo Vasconcelos de Freitas ◽  
Pedro Barreira Cabral ◽  
Caio Carvalho Morais ◽  
Bruno Silveira Pavei ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Femoral Condyle ◽  
Bone Marrow Lesion ◽  
Functional Improvement ◽  
Injection Technique ◽  
Pain Complaint ◽  
Total Knee ◽  
Phosphate Injection ◽  
Phosphate Treatment

Purpose This study aimed to compile available data in medical literature about subchondral calcium phosphate injection, comparing results obtained with this technique, as well as indications, complications, and other important factors in treatment of bone marrow lesions. Designs A literature review using PubMed and Medline database in order to identify works with terms “subchondral calcium phosphate injection,” “ subchondroplasty®,” “bone marrow lesion,” and “knee.” Eight relevant articles were found. Results A total of 164 patients with bone marrow lesion mainly on femoral condyle and tibial plateau recovered with significant functional improvement of knee after subchondral calcium phosphate treatment. Although 25% of them still had some type of pain complaint, they also showed improvement. There were few complications reported and return to activities occurred after 3 months on average. Conclusions Few studies evaluate the result of using subchondral calcium phosphate injection technique. However, all presented favorable results regarding pain and improvement of knee function. In addition, within 2 years, there was a 70% reduction in conversion to total knee arthroplasty in patients with previous surgical indication who choose calcium phosphate treatment.

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