Another cause of hip and knee pain – what you need to know about Bone Marrow Oedema

What is Bone Marrow Oedema (Bone Marrow Lesion)?

This is the result of a build-up of fluid inside the bone and can be due to injury or arthritis. The tiny strands within the bone called trabeculae can be under stress due to increased pressure and fluid build-up. Sometimes these strands may break under the increased pressure that can lead to pain and discomfort.

What are the symptoms?

The symptoms can range from mild to severe pain in the affected area. Swelling may be present but not obvious to the naked eye. Patients often have trouble walking and/or running, and they can also have persistent or recurrent pain and tenderness in the affected area. The activities of daily living may become impaired.

Who can present with it?

It can present in anyone from the non-athlete to elite athletes, in the absence of trauma and it can also present in arthritic patients.

It is recommended that patients with persistent pain in the absence of trauma should seek advice from their GP or specialist.

How is it diagnosed?

The diagnosis is made after a consultation discussing patient history, clinical examination and imaging investigations. If bone marrow oedema is suspected at the consultation, the specialist will likely to request an MRI scan to confirm the diagnosis.

What are the treatment options?

Once the diagnosis is confirmed, rest, pain relieving medication and physiotherapy, can treat the majority of bone marrow oedema cases.

However, surgery is recommended when non-surgical interventions have been unsuccessful. There are promising results in the management of the condition in early arthritis and in injury cases.

What happens during the procedure?

The procedure involves the decompression of the bone and the implantation of material to aid in the natural healing of the bone. Treatment is aimed at the affected area, filling the space affected by the oedema (lesion) and stimulating a biological healing response. Studies have shown significant improvements in pain relief and daily function for patients who have had the procedure – but every surgical procedure comes with risks, which will be discussed in detail with your specialist.

Surgery is performed as a day case and you can often return to work within 10 days. Following treatment, you can discuss your return to normal daily activities and sports with your specialist.

Mr Harold Nwaboku is a Consultant Orthopaedic Surgeon, with a special interest in joint preservation. He is part of the Orthopaedic faculty of the Royal Free London NHS Foundation Trust and has been treating patients with hip and knee problems since 1991.

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Some consider eradication of infection in orthopaedic surgery as the next frontier for our profession. Studies like these help us push forwards. 👏 to the authors.

Very high quality paper showing that surgery isn’t the answer.