[Bone marrow edema and atraumatic necrosis of the femoral head : Therapy]. / Knochenmarködem und atraumatische Femurkopfnekrose : Therapie.
Orthopade
; 44(9): 662-671, 2015 Sep.
Article
em De
| MEDLINE
| ID: mdl-26245631
ABSTRACT
BACKGROUND:
An increase in interstitial bony fluid occurs in bone-marrow edema (BME). The exact pathogenetic processes still remain unknown. BME is an unspecific finding that can occur on its own or accompany multiple diseases and pathologies. GOAL Literature review and presentation of new guidelines. MATERIAL ANDMETHODS:
This is a narrative literature review followed by current advice for the therapy of atraumatic osteonecrosis of the hip, based on the recently published S3-guidelines for this disease. RESULTS ANDDISCUSSION:
The differentiation of at least 3 different etiologies is proposed (mechanic, reactive and ischemic). Difficult, but important, is the distinction between the mostly painful, but benign entities (BME syndrome, bone bruise) and the progressive pathologies (osteonecrosis, arthritis, CRPS, tumour). Treatment options are dependent on etiology and clinic and can often be symptomatic. Core decompression is the surgical gold standard, leading to immediate pressure relief and therefore reduction in pain. Recently, it was shown that intravenous administration of Iloprost and bisphosphonates are also effective in achieving a reduction of BME and pain, with considerable improvement in the accompanying symptoms. The combination of core decompression and infusion seems to be another possible optimization ofthe therapy, in particular in the treatment of osteonecrosis.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ortopedia
/
Doenças da Medula Óssea
/
Descompressão Cirúrgica
/
Difosfonatos
/
Necrose da Cabeça do Fêmur
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Qualitative_research
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
De
Revista:
Orthopade
Ano de publicação:
2015
Tipo de documento:
Article