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Medikamentöse Therapie von Osteonekrosen

Drug treatment of osteonecrosis

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Zusammenfassung

Eine medikamentöse Therapie von Osteonekrosen wird als Teil einer konservativen Therapie für die atraumatische Femurkopfnekrose der Hüfte des Erwachsenen und für den Morbus Ahlbäck (SPONK [spontane Osteonekrose Kniegelenk]) am Kniegelenk beschrieben. Für die Femurkopfnekrose kommt Iloprost in frühen Stadien (ARCO I und II) als Heilversuch zum Einsatz, um den Schmerz und das begleitende Knochenmarködem zu beseitigen. Dies gilt auch für den Einsatz von Bisphosphonaten, wobei vorzugsweise kleine Defekte (< 30 %) zur Behandlung geeignet sind. Am Kniegelenk werden Bisphosphonate zur Behandlung des Morbus Ahlbäck erfolgreich eingesetzt, wobei die Resultate zum Teil widersprüchlich sind. Andere Lokalisationen, wie Humeruskopf, Talus, Skaphoid, Lunatum, proximale Tibia und Metatarsaleköpfchen, werden mit Bisphosphonaten zum Teil erfolgreich behandelt. Die Ergebnisse dazu scheinen zwar vielversprechend, jedoch sind die Gruppen viel zu klein, um diesbezügliche Behandlungsempfehlungen abzuleiten.

Abstract

The medicinal treatment of osteonecrosis is described as part of the conservative treatment for atraumatic femoral head necrosis of the hip in adults and for Ahlbäck’s disease of the knee joint. For femoral head necrosis, iloprost is used in the early stages (ARCO I and II) as a treatment attempt to eliminate pain and the accompanying bone marrow edema. This also applies to the use of bisphosphonates, whereby preferably small defects (< 30%) are suitable for treatment. Bisphosphonates are successfully used in the knee joint to treat Ahlbäck’s disease, although the results are sometimes contradictory. Other locations, such as the humeral head, talus, scaphoid, lunate, proximal tibia, and metatarsal head, are sometimes successfully treated with bisphosphonates. Although the results seem promising, the groups are far too small to derive treatment recommendations in this regard.

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Abbreviations

aFKN:

Atraumatische Femurkopfnekrose

ARCO :

Association Research Circulation Osseous

BMI :

Body-Mass-Index

HHS :

Harris Hip Score

KSS :

Knee Society Score

NSAR :

Nichtsteroidale Antirheumatika

SPONK :

Spontane Osteonekrose Kniegelenk

VAS :

Visuelle Analogskala

WOMAC :

Western Ontario and McMaster Universities Osteoarthritis Index

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Endoprothetik/Orthopädie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland

    Andreas Roth

  2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    Uwe Maus

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Correspondence to Andreas Roth.

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A. Roth und U. Maus geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Roth, A., Maus, U. Medikamentöse Therapie von Osteonekrosen. Orthopädie 51, 783–791 (2022). https://doi.org/10.1007/s00132-022-04300-2

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