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.
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
Literatur
Agarwala S, Jain D, Joshi VR, Sule A (2005) Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology 44(3):352–359. https://doi.org/10.1093/rheumatology/keh481
Agarwala S, Shah S, Joshi VR (2009) The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg Br 91(8):1013–1018. https://doi.org/10.1302/0301-620X.91B8.21518
Agarwala S, Banavali SD, Vijayvargiya M (2018) Bisphosphonate combination therapy in the management of postchemotherapy avascular necrosis of the femoral head in adolescents and young adults: a retrospective study from India. J Glob Oncol 4:1–11. https://doi.org/10.1200/JGO.17.00083
Agarwala S, Sharoff L, Jagani N (2020) Effect of zoledronic acid and alendronate on bone edema and pain in spontaneous osteonecrosis of the knee: a new paradigm in the medical management. Rev Bras Ortop (Sao Paulo) 55(5):543–550. https://doi.org/10.1016/j.rboe.2017.12.008
Agarwala S, Vijayvargiya M (2019) Bisphosphonate combination therapy for non-femoral avascular necrosis. J Orthop Surg Res 14(1):112. https://doi.org/10.1186/s13018-019-1152-7
Aglietti P, Insall JN, Buzzi R, Deschamps G (1983) Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg Br 65(5):588–597. https://doi.org/10.1302/0301-620X.65B5.6643563
Aigner N, Petje G, Schneider W, Meizer R, Wlk M, Kotsaris S et al (2005) Bone marrow edema syndrome of the femoral head: treatment with the prostacyclin analogue iloprost vs. core decompression: an MRI-controlled study. Wien Klin Wochenschr 117(4):130–135. https://doi.org/10.1007/s00508-005-321-3
Bhatnagar N, Sharma S, Gautam VK, Kumar A, Tiwari A (2018) Characteristics, management, and outcomes of spontaneous osteonecrosis of the knee in Indian population. Int Orthop 42(7):1499–1508. https://doi.org/10.1007/s00264-018-3878-y
Claßen T, Becker A, Landgraeber S, Haversath M, Xinning L, Zilkens C et al (2016) Long-term clinical results after Iloprost treatment for bone marrow edema and avascular necrosis. Orthop Rev (Pavia) 8(1):6150. https://doi.org/10.4081/or.2016.6150
Disch AC, Matziolis G, Perka C (2005) The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br 87(4):560–564. https://doi.org/10.1302/0301-620X.87B4.15658
Jäger M, Werner A, Lentrodt S, Mödder U, Krauspe R (2004) Schmerztherapie bei nichtjuvenilen, aseptischen Osteonekrosen. Schmerz 18(6):481–491. https://doi.org/10.1007/s00482-004-0356-9
Jureus J, Lindstrand A, Geijer M, Roberts D, Tägil M (2012) Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate. Acta Orthop 83(5):511–514. https://doi.org/10.3109/17453674.2012.729184
Kang P, Fuxing P, B Shen B, Zongke Z, Yang J (2012) Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Joint Bone Spine 79(1):67–72. https://doi.org/10.1016/j.jbspin.2011.02.020
Kraenzlin ME, Graf C, Meier C, Kraenzlin C, Friedrich NF (2010) Possible beneficial effect of bisphosphonates in osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 18(12):1638–1644. https://doi.org/10.1007/s00167-010-1106-4
Lai K‑A, Shen W‑J, Yang C‑Y, Shao C‑J, Hsu J‑T, Lin R‑M (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 87(10):2155–2159. https://doi.org/10.2106/JBJS.D.02959
Lee Y‑K, Ha Y‑C, Cho YJ, Suh KT, Kim S‑Y, Won Y‑Y et al (2015) Does zoledronate prevent femoral head collapse from osteonecrosis? A prospective, randomized, open-label, multicenter study. J Bone Joint Surg Am 97(14):1142–1148. https://doi.org/10.2106/JBJS.N.01157
Luo R‑B, Tiao L, Hui-Ming Z, Shi-Gui Y, Wang J‑A (2014) Evidence for using alendronate to treat adult avascular necrosis of the femoral head: a systematic review. Med Sci Monit 20:2439–2447. https://doi.org/10.12659/MSM.891123
Maus U, Flechtenmacher J, Peters KM (2018) Konservative Therapie der atraumatischen Hüftkopfnekrose. Orthopäde 47(9):735–744. https://doi.org/10.1007/s00132-018-3616-6
Meier C, Kraenzlin C, Friederich NF, Wischer T, Grize L, Meier CR, Kraenzlin ME (2014) Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial. Osteoporos Int 25(1):359–366. https://doi.org/10.1007/s00198-013-2581-5
Meizer R, Radda C, Stolz G, Kotsaris S, Petje G, Krasny C et al (2005) MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost. Wien Klin Wochenschr 117(7):278–286. https://doi.org/10.1007/s00508-005-0326-y
Nishii T, Sugano N, Hidenobu M, Hashimoto J, Yoshikawa H (2006) Does alendronate prevent collapse in osteonecrosis of the femoral head? Clin Orthop Relat Res 443:273–279. https://doi.org/10.1097/01.blo.0000194078.32776.31
Roth A, Beckmann J, Bohndorf K, Heiß C, Jäger M, Landgraeber S et al (2018) Update S3-Leitlinie Atraumatische Femurkopfnekrose des Erwachsenen. Orthopäde 47(9):757–769. https://doi.org/10.1007/s00132-018-3620-x
Sibilska A, Góralczyk A, Hermanowicz K, Malinowski K (2020) Spontaneous osteonecrosis of the knee: what do we know so far? A literature review. International Orthopaedics (SICOT) 44(6):1063–1069. https://doi.org/10.1007/s00264-020-04536-7
Soucacos PN, Xenakis TH, Beris AE, Soucacos PK, Georgoulis A (1997) Idiopathic osteonecrosis of the medial femoral condyle. Classification and treatment. Clin Orthop Relat Res 341:82–89
Zywiel MG, McGrath MS, Seyler TM, Marker DR, Bonutti PM, Mont MA (2009) Osteonecrosis of the knee: a review of three disorders. Orthop Clin North Am 40(2):193–211. https://doi.org/10.1016/j.ocl.2008.10.010
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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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DOI: https://doi.org/10.1007/s00132-022-04300-2