[Avascular necrosis of the hip - diagnosis and treatment]. / Hüftkopfnekrose - Diagnostik und Differenzialtherapie.
Z Orthop Unfall
; 149(2): 231-40; quiz 241-2, 2011 Apr.
Article
em De
| MEDLINE
| ID: mdl-21469042
ABSTRACT
Femoral head necrosis is an ischaemic bone necrosis of traumatic or nontraumatic pathogenesis which can lead to hip joint destruction in young age. It is today the indication for 10 % of all the total hip joint replacements. Known aetiologies of nontraumatic femoral head necrosis are alcoholism, steroids, sickle cell anaemia, caisson, and Gaucher's disease. Further risk factors are chemotherapy, chronic inflammatory bowel disease, systemic lupus erythematosus, and multiple sclerosis, in which also steroids are involved. Gravidity is another risk factor, but still idiopathic pathogenesis is found. In diagnosis, the ARCO-classification of the Association for the Research of Osseous Circulation is essential. While stage 0 can only be found histologically, the reversible early stage 1 shows MR signal changes. In the irreversible early stage 2, first native x-ray changes are seen as lower radiolucency reflects new bone apposition on dead trabeculae. In stage 3, subchondral fracture follows, and in stage 4 secondary arthritis of the hip. Established therapy in stage 1 is core decompression, physiotherapy, and more and more also bisphosphonates. Sufficient data to support extracorporeal shock wave therapy are still lacking. Stem cell therapy seems to be a promising new therapy method in stage 2. In stage 2 and 3 mainly proximal femoral osteotomies and (non)vascularised bone transplantation are performed. In stage 4, depending on size and location of the necrotic zone and pathology of the adjacent bone, resurfacing or short stem hip arthroplasty can be performed. However, conventional THA is still golden standard. The problem and challenge, however, is the often young patient age in femoral head necrosis. Especially chemotherapy-associated osteonecrosis in leukaemia is found in patients in their second decade of life. Therefore, the hip should be preserved as long as possible.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Diagnóstico por Imagem
/
Artroplastia de Quadril
/
Necrose da Cabeça do Fêmur
Tipo de estudo:
Diagnostic_studies
Limite:
Humans
Idioma:
De
Revista:
Z Orthop Unfall
Assunto da revista:
ORTOPEDIA
/
TRAUMATOLOGIA
Ano de publicação:
2011
Tipo de documento:
Article