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Operative Therapiekonzepte der Hüftkopfnekrose

Surgical treatment concepts for femoral head necrosis

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Zusammenfassung

Die Osteonekrose des Femurkopfs führt unbehandelt zu einer Zerstörung des Hüftgelenks. In Abhängigkeit von der Lokalisation und der Ausdehnung der Osteonekrose stehen verschiedene operative Verfahren zur Verfügung. Die Frühformen der Erkrankung mit kleinen bis mittleren präkollaptischen Läsionen können durch Hüftkopfbohrungen behandelt werden. Umstellungsosteotomien und Knochentransplantationen stellen Therapiemöglichkeiten sowohl bei mittleren präkollaptischen als auch bei kleineren postkollaptischen Läsionen dar. Liegen Knorpelschäden des koxalen Femurendes vor, sollte eine Oberflächenersatzprothese zum Einsatz kommen. Weist das Acetabulum ebenfalls Knorpelläsionen auf, ist die Implantation einer Hüfttotalendoprothese erforderlich.

Abstract

Osteonecrosis of the femoral head eventually leads to the destruction of the femoral head, if it remains untreated. Depending on the localization and the extent of the osteonecrosis several surgical treatment options can be considered. For early small and medium-sized pre-collapse lesions, core decompression is the treatment of choice. Osteotomies and bone grafting procedures can be utilized in medium pre-collapse, as well as in small post-collapse lesions. Cartilage lesions of the femoral head allow limited femoral resurfacing arthroplasty. If the acetabulum reveals cartilage lesions, a total hip replacement should be preformed.

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Literatur

  1. Adili A,Trousdale RT (2003) Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop 417: 93–101

    PubMed  Google Scholar 

  2. ARCO, Osseous (ARC) (1992) Committee on terminology and classification. ARCO News 4: 41–46

    Google Scholar 

  3. Atsumi T,Kuroki Y (1997) Modified Sugioka’s osteotomy: more than 130 degrees posterior rotation for osteonecrosis of the femoral head with large lesion. Clin Orthop 334: 98–107

    PubMed  Google Scholar 

  4. Atsumi T, Muraki M, Yoshihara S,Kajihara T (1999) Posterior rotational osteotomy for the treatment of femoral head osteonecrosis. Arch Orthop Trauma Surg 119: 7–8; 388–393

    Article  PubMed  Google Scholar 

  5. Beaule PE, Schmalzried TP, Campbell P et al. (2001) Duration of symptoms and outcome of hemiresurfacing for hip osteonecrosis. Clin Orthop 385: 104–117

    Article  PubMed  Google Scholar 

  6. Berend KR, Gunneson EE,Urbaniak JR (2003) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85 6: 987–993

    Google Scholar 

  7. Castro FP Jr, Barrack RL (2000) Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop 29 3: 187–194

    Google Scholar 

  8. Chan YS, Shih CH (2000) Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient. Clin Orthop 379: 169–177

    Article  PubMed  Google Scholar 

  9. Cuckler JM, Moore KD, Estrada L (2004) Outcome of hemiresurfacing in osteonecrosis of the femoral head. Clin Orthop 429: 146–150

    Article  PubMed  Google Scholar 

  10. Dean MT, Cabanela ME (1993) Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg Br 75 4: 597–601

    Google Scholar 

  11. Dienst M, Kohn D (2000) Osteonecrosis of the hip joint in adulthood. Significance of various corrective osteotomies. Orthopäde 29(5): 430–441

    PubMed  Google Scholar 

  12. Etienne G, Mont MA,Ragland PS (2004) The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head. Instr Course Lect 53 67–85

    Google Scholar 

  13. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS (1995) Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 77(1): 42–49

    PubMed  Google Scholar 

  14. Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67(1): 3–9

    PubMed  Google Scholar 

  15. Fuchs B, Knothe U, Hertel R, Ganz R (2003) Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis. Clin Orthop 412: 84–93

    Article  PubMed  Google Scholar 

  16. Grevitt MP,Spencer JD (1995) Avascular necrosis of the hip treated by hemiarthroplasty. Results in renal transplant recipients. J Arthroplasty 10(2): 205–211

    PubMed  Google Scholar 

  17. Hofmann S, Kramer J, Leder K et al. (1994) The non-traumatic femur head necrosis in the adult. I: pathophysiology, clinical picture and therapeutic options. Radiologe 34 1: 1–10

    Google Scholar 

  18. Hungerford MW, Mont MA (2000) Die potenziellen Anwendungen von Zytokinen und Wachstumsfaktoren bei der Behandlung der Osteonekrose. Orthopäde 29(5): 442–448

    Article  PubMed  Google Scholar 

  19. Hungerford MW, Mont MA, Scott R et al. (1998) Surface replacement hemiarthroplasty for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 80 11: 1656–1664

    Google Scholar 

  20. Kim SY, Kim YG, Kim PT et al. (2005) Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am 87(9): 2012–2018

    Article  PubMed  Google Scholar 

  21. Lavernia CJ, Sierra RJ, Grieco FR (1999) Osteonecrosis of the femoral head. J Am Acad Orthop Surg 7(4): 250–261

    PubMed  Google Scholar 

  22. Lee SB, Sugano N, Nakata K et al. (2004) Comparison between bipolar hemiarthroplasty and THA for osteonecrosis of the femoral head. Clin Orthop 424: 161–165

    Article  PubMed  Google Scholar 

  23. Lieberman JR, Conduah A, Urist MR (2004) Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop 429: 139–145

    Article  PubMed  Google Scholar 

  24. Marcus ND, Enneking WF, Massam RA (1973) The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting. J Bone Joint Surg Am 55(7): 1351–1366

    PubMed  Google Scholar 

  25. Matsusaki H, Noguchi M, Kawakami T, Tani T (2005) Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 125(2): 95–101

    Article  PubMed  Google Scholar 

  26. Mazieres B, Marin F, Chiron P et al. (1997) Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head. Ann Rheum Dis 56(12): 747–750

    PubMed  Google Scholar 

  27. Mont MA, Carbone JJ, Fairbank AC (1996) Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop 324: 169–178

    Article  PubMed  Google Scholar 

  28. Mont MA, Etienne G, Ragland PS (2003) Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop 417: 84–92

    PubMed  Google Scholar 

  29. Mont MA, Fairbank AC, Krackow KA, Hungerford DS (1996) Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am 78(7): 1032–1038

    PubMed  Google Scholar 

  30. Mont MA, Jones LC, Hungerford DS (2006) Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 88 5: 1117–1132

    Article  Google Scholar 

  31. Mont MA, Ragland PS, Etienne G (2004) Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop 429: 131–138

    Article  PubMed  Google Scholar 

  32. Mont MA, Rajadhyaksha AD, Hungerford DS (2001) Outcomes of limited femoral resurfacing arthroplasty compared with total hip arthroplasty for osteonecrosis of the femoral head. J Arthroplasty 16(8 Suppl 1): 134–139

    Article  PubMed  Google Scholar 

  33. Nakamura Y, Kumazawa Y, Mitsui H et al. (2005) Combined rotational osteotomy and vascularized iliac bone graft for advanced osteonecrosis of the femoral head. J Reconstr Microsurg 21: 101–105

    Article  PubMed  Google Scholar 

  34. Ohzono K, Saito M, Takaoka K et al. (1991) Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 73: 68–72

    PubMed  Google Scholar 

  35. Plenk H Jr, Hofmann S, Breitenseher M, Urban M (2000) Pathomorphological aspects and repair mechanisms of femur head necrosis. Orthopäde 29: 389–402

    PubMed  Google Scholar 

  36. Reichelt A, Tonn S (1977) Surgical treatment of ischemic femur head necrosis. Orthop Traumatol 24: 675–685

    Google Scholar 

  37. Rijnen WH, Gardeniers JW, Buma P et al. (2003) Treatment of femoral head osteonecrosis using bone impaction grafting. Clin Orthop 417: 74–83

    PubMed  Google Scholar 

  38. Rosenwasser MP, Garino JP, Kiernan HA, Michelsen CB (1994) Long term followup of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop 306: 17–27

    PubMed  Google Scholar 

  39. Rossig S, Kohn D, Daentzer D (1997) Intertrochanteric flexion osteotomy and allo-arthroplasty in femur head necrosis. A comparative retrospective study. Z Orthop Ihre Grenzgeb 135: 24–30

    PubMed  Google Scholar 

  40. Sanjay BK, Moreau PG (1996) Bipolar hip replacement in sickle cell disease. Int Orthop 20: 222–226

    Article  PubMed  Google Scholar 

  41. Scher MA, Jakim I (1993) Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head. J Bone Joint Surg Am 75: 1119–1133

    PubMed  Google Scholar 

  42. Scully SP, Aaron RK, Urbaniak JR (1998) Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 80: 1270–1275

    PubMed  Google Scholar 

  43. Shannon BD, Trousdale RT (2004) Femoral osteotomies for avascular necrosis of the femoral head. Clin Orthop 418: 34–40

    Article  PubMed  Google Scholar 

  44. Steinberg ME, Steinberg DR (2004) Classification systems for osteonecrosis: an overview. Orthop Clin North Am 35: 273–283

    Article  PubMed  Google Scholar 

  45. Sugano N, Takaoka K, Ohzono K et al. (1992) Rotational osteotomy for non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 74: 734–739

    PubMed  Google Scholar 

  46. Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop 277: 111–120

    PubMed  Google Scholar 

  47. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 77: 681–694

    PubMed  Google Scholar 

  48. Wagner H, Baur W, Wagner M (1990) Joint-preserving osteotomy in segmental femur head necrosis. Orthopäde 19: 208–218

    PubMed  Google Scholar 

  49. Yamano K, Atsumi T, Kajiwara T et al. (2003) Bipolar endoprothesis for osteonecrosis of the femoral head: a 12-year follow-up of 29 hips. Annual meeting of the Association Reserach Circulation Osseous Jeju Island, South Korea

    Google Scholar 

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  1. Abteilung für Rheumaorthopädie, Johann-Wolfgang-Goethe-Universität, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland

    D. von Stechow

  2. Orthopädische Universitätsklinik Mainz, Mainz, Deutschland

    P. Drees

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  1. D. von Stechow
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  2. P. Drees
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Correspondence to D. von Stechow.

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von Stechow, D., Drees, P. Operative Therapiekonzepte der Hüftkopfnekrose. Orthopäde 36, 451–457 (2007). https://doi.org/10.1007/s00132-007-1085-4

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