how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)Don't have an exact number, but it's not uncommon to improve, and I'm often amazed of how well some seemingly terrible looking hips can end up, given time. Conditions with bone marrow edema are generally painful. I believe bone marrow edema in itself is causing much of the pain. The edema will usually / eventually resolve in time. A few months at least. Sometimes more than half a year. When / if the edema is gone, remaining pain will often depend on how damaged the joint surfaces are, and degree of osteoarthritis. From the description you quoted, it's not too damaged now. "Mild depression of the joint surface, mild cartilage thinning", I have an image in my head how that looks, and it's not too bad. As long as the joint surface isn't completely destroyed - and it isn't on those exams he's taken - there is a chance yet he could avoid THA.There is a chance it may develop into further joint destruction, but can only wait and see for that. Follow-up MRI 3-6 months after the first, maybe, depends on the clinical situation. Regular xray is often enough to assess damage to the joint surface.Also - while I'm not really questioning the diagnosis he's given, there are different conditions that causes bone marrow edema in the femoral head. "Transient migratory osteoporosis" is self limiting, and possible to mix up with osteonecrosis.
hanks for the reply. We know he would need another replacement in his life time (or multiple replacements of the hardware) if he were to have it replaced now, although the rate of failure of that THA is what is unknown to me and what nobody seems to have discussed with us. My best friends mother had bilateral THA in her teens and is in her 50s now with an additional 3 replacements, and is still healthy, so I may have some rose colored glasses with the n=1 sample size there. I think I will look up the data about revisions.I worry so much because I see his QOL just deteriorating in front of me. He doesnt want to die, but I know he doesnt want to live like this. Not just the pain but being unable to do what he finds meaningful. Pain management is great when theres a positive end in sight, but if its going to be a long-term that has a very high likelihood of ending in THA anyway, I cant imagine he would want to live like that. The trajectory hasnt been good so far, and Im somebody that needs hard data and numbers to reconcile any differences between patterns I see and what I am told might happen. As a radiologist, you may not have an answer, but how often do you see patients actually improving without hip prosthesis once their MRI looks like my husbands (or, can be described like my husbands)? Do you get to know who is symptomatic and how symptomatic? Previously I was trying to find studies or case studies and just couldnt find anything promising myself, and I was also focused on the quality of his pain, since there seems to be a different type of pain now.Along the same vein, how often is common to repeat images while waiting? How quickly have you seen deterioration? Its only been 5 weeks since the MRI and just shy of 3 months since the X-ray, but I am worried about how its progressing and wondering if it may not be as early or mild now as it was then.