Zusammenfassung
Die nichttraumatische Hüftkopfnekrose oder avaskuläre Femurkopfnekrose (FKN) stellt nicht nur ein operatives, sondern insbesondere ein pharmakotherapeutisches Problem dar, da nur wenige relevante Studien existieren, die den Verlauf der FKN unter medikamentöser Therapie oder gegenüber Placebo über einen längeren Zeitraum untersucht haben. Hierzu gehören die Applikation von vasodilatierenden Prostaglandinanaloga wie Iloprost als auch Knochenprotektiva aus der Gruppe der Bisphosphonate. Weitere Ansätze beinhalten die Gabe von Antikoagulanzien wie niedermolekulares Heparin, Lipidsenker und Hormonderivate wie Stanozolol.
Interessanterweise zeigen die meisten dieser Studien eine signifikante Verbesserung der Schmerzsymptomatik und eine Verhinderung einer raschen Progression der FKN, was sich auch in einer reduzierten Zahl an notwendigen prothetischen Eingriffen über mehrere Jahre widerspiegelt. Zu betonen ist, dass eine medikamentöse Intervention so rasch als möglich erfolgen sollte, da frühere Stadien der FKN in der Regel deutlich besser als späte Stadien mit bereits erfolgter Osteodestruktion auf eine Medikation ansprechen.
Abstract
Avascular necrosis (AVN) of the hip is one of the unsolved problems in orthopedics, especially with regard to drug therapy. Only a few studies exist using a long-term approach with vasodilating agents such as prostaglandins, anticoagulants, hormones, as well as lipid lowering and bone protective drugs such as bisphosphonates. However, using these medications several studies have demonstrated a significant reduction in pain, in the destruction of the femoral head as well as in overall disability. This resulted in a reduced need for joint replacement in patients with AVN and to a substantial improvement in quality of life. Of note, drug therapy should be initiated in the early phases of AVN as later stages appear to be less responsive to medication.
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Tarner, I., Dinser, R. & Müller-Ladner, U. Pharmakotherapeutische Aspekte der Femurkopfnekrose. Orthopäde 36, 446–450 (2007). https://doi.org/10.1007/s00132-007-1084-5
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DOI: https://doi.org/10.1007/s00132-007-1084-5