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Stellenwert der Ausräumung bei der Behandlung von Femurkopfosteonekrosen

The importance of removing osteonecrosis during treatment of femoral head osteonecrosis

Zusammenfassung

Die atraumatische Femurkopfnekrose (aFKN) des Erwachsenen ist Ursache für ca. 10 % aller Hüftprothesenimplantationen. Aufgrund des relativ häufigen Auftretens einer aFKN im bereits jungen Lebensalter, sollte bei den Betroffenen die Möglichkeit eines gelenkerhaltenden Eingriffs geprüft werden. Dazu zählt die klassische Entlastungsbohrung „core decompression“ und darauf basierende Modifikationen. Zu der Erfolgsrate dieser Methode gibt es unterschiedliche Angaben. Gründe für ein Therapieversagen könnten unter anderem in der fehlenden Ausräumung der Nekrosezone liegen. Diesen Ansatz greifen alternative operative Verfahren zur Behandlung der aFKN auf. Dazu zählen die „Trap-door“-Methode, die „Ligth-bulb“-Methode und die „advanced core decompression“. Der aktuelle Wissensstand zu den genannten Verfahren wird in diesem Leitthemenbeitrag aufgearbeitet. Dabei zeigt sich, dass der ausgiebigen Ausräumung der Femurkopfnekrose eine besondere Bedeutung zukommt. Keines der genannten Verfahren kann aktuell bevorzugt empfohlen werden.

Abstract

Atraumatic femoral head necrosis (aFHN) in adults is estimated to be the leading cause of approximately 10% of all hip prosthesis implantations. Due to the relatively frequent occurrence of aFHN at a young age, the possibility of a joint-preserving intervention should be examined. This includes the classic “core decompression” and modifications based on it. There are different data on the success rates of this method. Reasons for treatment failure could include a lack of clearance of the necrosis zone. The clearance of the necrosis zone is taken into account by alternative surgical procedures for the treatment of aFHN. These are the “trap-door procedure”, the “light-bulb procedure” and “advanced core decompression”. The current state of knowledge on these procedures is reviewed in this keynote article. It is shown that the extensive excision of femoral head necrosis is of particular importance. None of the procedures mentioned can currently be recommended in preference over the others.

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Abbreviations

ACD:

„Advanced core decompression“

aFKN:

Atraumatische Femurkopfnekrose

ARCO:

Association Research Circulation Osseous

BMI :

Body-Mass-Index

mACD:

„Modified advanced core decompression“

ON:

Osteonekrose

PMMA :

Polymethylmethacrylat

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Correspondence to Philipp Winter.

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P. Winter und S. Landgraeber geben an, dass kein Interessenkonflikt besteht.

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Winter, P., Landgraeber, S. Stellenwert der Ausräumung bei der Behandlung von Femurkopfosteonekrosen. Orthopädie 51, 800–807 (2022). https://doi.org/10.1007/s00132-022-04302-0

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Schlüsselwörter

  • Osteonekrosen
  • Arthrose
  • Femurkopfnekrose
  • Hüfte
  • Gelenkerhalt

Keywords

  • Osteonecrosis
  • Arthrosis
  • Femur head necrosis
  • Hip
  • Joint preservation