“Full moon-like” imaging appearance of the femoral head bone marrow edema treated with mini-open core decompression combined with platelet-rich plasma: A technical report

Bone marrow edema (BME) of the hip is a painful condition that may cause significant functional limitation. When conservative treatment fails, surgical and pharmacological options may be required. This technical note reports the outcome of a patient with extensive femoral head-and-neck BME treated with core decompression, intraosseous platelet-rich plasma (PRP), intravenous zoledronic acid, and temporary non-weight bearing. A 39-year-old male basketball player presented with persistent left hip pain and gait disturbance refractory to conservative management. Magnetic resonance imaging (MRI) demonstrated extensive BME of the femoral head and neck. The patient underwent percutaneous multiple drilling core decompression with intraosseous PRP injection, followed by a single postoperative dose of intravenous zoledronic acid (5 mg) and 4 weeks of non-weight bearing. The postoperative course was uneventful. Rapid pain relief and functional improvement were observed. Follow-up MRI showed complete resolution of BME at 8 weeks. At 3 months, the patient had returned to normal daily activities without symptoms. Combined core decompression, intraosseous PRP, and intravenous zoledronic acid may represent a safe and effective option for extensive or persistent hip BME; however, the individual effect of each component cannot be determined, and further controlled studies are required.