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Konservative Therapie der atraumatischen Hüftkopfnekrose

  • U. Maus
  • J. Flechtenmacher
  • K. M. Peters
Leitthema
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Zusammenfassung

Hintergrund

Die Hüftkopfnekrose ist eine progredient verlaufende Erkrankung, welche innerhalb relativ kurzer Zeit fortschreiten kann. Daher ist eine frühzeitige und klare Diagnostik inkl. Stadienklassifikation und Therapie notwendig, um das Einbrechen des Hüftkopfes und die Gelenkdestruktion zu verhindern bzw. zu verzögern.

Therapie

Neben der Identifikation möglicher Risikofaktoren und der Behandlung stellt sich die Frage der verfügbaren Therapieoptionen. Der vorliegende Beitrag beschäftigt sich mit den konservativen Therapieoptionen und stellt die publizierten Ergebnisse im Sinne der derzeit besten verfügbaren Evidenz und vor dem Hintergrund der S3-Leitlinie zum Thema der atraumatischen Hüftkopfnekrose dar. Dabei werden die Ergebnisse der physikalischen Therapie, medikamentösen Therapie (Iloprost und Bisphosphonate), Elektrotherapie, Stoßwellentherapie etc. aufgezeigt. In frühen Stadien der Hüftkopfnekrose mit geringer Ausdehnung liegen für Alendronat positive Ergebnisse vor. Auch Iloprost ist in den frühen Stadien der atraumatischen Femurkopfnekrose (ARCO I und II) eine erfolgreiche konservative Therapieoption. In Stadium ARCO III und IV ist Ilomedin nicht mehr indiziert. Antikoagulantien, wie Enoxaparin, haben Nachweise über eine arthroprotektive Wirkung gezeigt.

Schlüsselwörter

Bisphosphonate Elektrostimulation Femurkopf Electric Stimulation Therapy Pulsierende elektromagnetische Felder 

Abkürzungen

aFKN

Aseptische Femurkopfnekrose

ARCO

Association Research Circulation Osseous

CD

Anbohrung

ES

Elektrische Stimulation

ESWT

Stoßwellentherapie

FU

Follow-up

HBO

Hyperbare Sauerstofftherapie

HHS

Harris Hip Score

INR

International Normalized Ratio

NSAR

Nichtsteroidale Antirheumatika

PEMF

Pulsierende elektromagnetische Felder

SP

Spongiosaplastik

TEP

Totalendoprothese

VAS

Visuelle Analogskala

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index

Conservative treatment of atraumatic femoral head necrosis

Abstract

Background

Femoral head necrosis is a progressive disease that can progress within a relatively short time. Therefore, an early and clear diagnosis including stage classification and treatment is necessary to prevent or delay the onset of the femoral head and joint destruction.

Treatment

In addition to the identification of possible risk factors and treatment, the question of the available treatment options arises. The present article deals with conservative treatment options and presents the published results in the sense of the currently available evidence and against the background of the S3 guideline on atraumatic femoral head necrosis. The results of physical therapy, drug therapy (iloprost and bisphosphonates ), electrotherapy, shockwave therapy, etc. are presented. In the early stages of femoral head necrosis with low expansion, alendronate gives positive results. Iloprost is also a successful conservative treatment option in the early stages of atraumatic femoral head necrosis (ARCO I and II). In stages ARCO III and IV, Ilomedin is no longer indicated. Anticoagulants, such as enoxaparin, have demonstrated an arthroprotective effect.

Keywords

Bisphosphonates Electric stimulation therapy Femur head High-energy shock waves Iloprost 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

U. Maus, J. Flechtenmacher und K. M. Peters geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Universitätsklinik für Orthopädie und UnfallchirurgiePius-Hospital OldenburgOldenburgDeutschland
  2. 2.Orthopädische Gemeinschaftspraxis am LudwigsplatzKarlsruheDeutschland
  3. 3.Orthopädie und OsteologieDr. Becker Rhein-Sieg-KlinikNümbrechtDeutschland

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