Treatment of Bone Marrow Edema of the Foot and Ankle With the Prostacyclin Analog Iloprost.

BACKGROUND: Bone marrow edema (BME) of the foot and ankle is challenging to treat. One approach is intravenous Iloprost treatment, which is a vasoactive prostacyclin analog. The aim of this study was to evaluate the early and intermediate outcome of intravenous Iloprost therapy on BME of the foot and ankle and to analyze the influence of its etiology and Association Research Circulation Osseous (ARCO) stage on the outcome. METHODS: This was a retrospective study with prospective follow-up. All patients treated by intravenous Iloprost for BME of the foot and ankle (ARCO I-III) at a single orthopedic reference center were included. Demographics, medical history, and MRIs were assessed prior to treatment (t0). MRIs were used to assess the BMEs' etiology (idiopathic/ischemic/metabolic, mechanical/degenerative, traumatic) and severity (ARCO). Complications as well as changes in pain, treatment, and MRI were evaluated after 3 months (t1). The following patient-rated outcome measures (PROMs) were assessed prospectively (t2): 12-Item Short Form Health Survey (SF-12), Visual Analog Scale Foot and Ankle (VAS FA), and the Foot Function Index (FFI) (also at t0). The descriptive outcomes and the influence of the etiology and ARCO on the outcome parameters were evaluated. Out of 70 eligible patients, 42 patients (60%; 47 ± 15 years; 30% female) with a mean follow-up of 28 ± 19 months were included. RESULTS: Twelve patients reported minor complications during Iloprost therapy. At t1, pain decreased significantly in 56%, and the amount of BME decreased in 83% of patients. Both parameters correlated moderately (r = -0.463, P = .015). The PROMs at t2 revealed moderate results. The overall FFI improved from 59 ± 21 to 30 ± 22 ( P < .001), the overall VAS FA was 68 ± 20, the SF-12 Physical Component Summary 42 ± 12 and Mental Component Summary 50 ± 9. Subgroup analysis revealed no significant influence of the etiology or ARCO stage on any outcome measure. CONCLUSION: Iloprost therapy for BME of the foot and ankle resulted in a 60% pain and 80% edema decrease after 3 months. After 2 years, patient-rated outcome measures showed residual impairment. Neither the etiology nor ARCO stage significantly influenced the outcome. LEVEL OF EVIDENCE: Level III, comparative study.

Quality of Life in orthognathic surgery patients: post-surgical improvements in aesthetics and self-confidence.

The objective of this prospective study was to assess changes of Quality of Life (QoL) in patients undergoing bimaxillary orthognathic surgery. Questionnaires were based on the Oral Health Impact Profile (OHIP, items OH-1-OH-14) and three additional questions (items AD-1-3), and were completed by patients (n=50; mean age 26.9±9.9 years) on average 9.1±2.4 months before surgery, and 12.1±1.4 months after surgery, using a scoring scale. Item scores describing functional limitation, physical pain, physical disability and chewing function did not change significantly, whereas item scores covering psychological discomfort and social disability domains revealed significant decreases following surgery. AD-2 "dissatisfying aesthetics" revealed the greatest difference between pre- and post-surgical scores (p<0.001). If there was a perception of aesthetic improvement of facial features post-surgery, the benefit in QoL was generally high. The significant correlation of the pre- to post-surgical changes of item OH-5 "self conscious" to nearly all other item changes suggested that OH-5 was the most sensitive indicator for post-surgical improvement of QoL. Psychological factors and aesthetics exerted a strong influence on the patients' QoL, and determined major changes more than functional aspects did.

Changes in quality of life and their relation to cephalometric changes in orthognathic surgery patients.

OBJECTIVE: To evaluate correlations between presurgical and postsurgical changes in quality of life (QoL) and cephalometric hard and soft tissue changes in patients undergoing orthognathic surgery. MATERIALS AND METHODS: The study sample consisted of 30 patients (mean age 24.3 ± 4.5 years) with Class III malocclusion undergoing orthognathic surgery for mandibular setback with a median follow-up of 8.3 ± 1.2 months. Presurgical and postsurgical cephalograms were traced and Oral Health Impact Profile (OHIP) questionnaires were completed. Each questionnaire consisted of 14 items designed to evaluate functional, physical, psychological, and social impacts. RESULTS: Significant correlations between significant presurgical-to-postsurgical changes in individual items and OHIP parameters were found between labiomental angle (LA) and question 5 ("feeling self-conscious"; correlation coefficient [r]  =  0.530), between LA and question 6 ("feeling tense"; r  =  0.598), between nasion-pogonion and question 5 (r  =  0.523), and between facial convexity and question 5 (r  =  -0.540). Hence, reduction of both LA and nasion-pogonion led to a significant decrease in the impact scores of items covering psychological discomfort, while reduced facial convexity led to increased impact scores. CONCLUSIONS: Although the associations were moderate, changes in QoL following cephalometric modifications should be considered as a major concern when planning orthognathic surgery. Postsurgical changes to a more convex profile after mandibular setback should be emphasized before surgery to help patients become accustomed to their new appearance more easily without negatively affecting QoL.