Gelenkerhaltende Operationen bei atraumatischer Femurkopfnekrose

Zusammenfassung

Neben nichtoperativen Behandlungsstrategien und dem endoprothetischen Gelenkersatz nehmen gelenkerhaltende Operationstechniken am Hüftgelenk eine Zwischenstellung in der Therapie der avaskulären Osteonekrose (AVN) ein. Die einzelnene Verfahren verfolgen hierbei verschiedene Ziele. Neben der seit vielen Jahren etablierten Entlastungsbohrung (Core Decompression), der Spongiosaplastik und aktueller innovativer Therapien (autologe Zelltherapie, Osteonekrosenagel, femoraler Teilgelenkersatz) besteht in ausgewählten Fällen die Indikation, ein betroffenes Osteonekroseareal durch eine Umstellungsosteotomie aus der Hauptbelastungszone zu schwenken. Die Entscheidung für hüftgelenknahe Osteotomien ist jedoch aufgrund eigener Erfahrungen sowie unter Berücksichtigung von umfangreichen Daten aus der wissenschaftlichen Literatur kritisch zu stellen, da bei bereits primär kritischer Durchblutung des Femurkopfes diese operationsbedingt zusätzlich beeinträchtigt werden können und sich das mittelfristige klinische Ergebnis im Einzelfall nur sehr schwer vorhersagen lässt. Ob minimalinvasive und regenerative Therapien zukünftig einen festen Stellenwert in der Behandlung der Femurkopfnekrose einnehmen werden, wird derzeit anhand experimenteller und klinischer Studien untersucht.

Summary

In addition to non-operative treatment strategies and total hip replacement, joint preserving sugeries are also indicated in defined stages of avascular necrosis (AVN) of the femoral head. These techniques are aiming different goals. Beside the well established concept of local core decompression by drilling of the affected area, the transplantation of autologous cancellous bone and other innovative alternatives such as cell therapy, avascular osteonecrosis rod, and partial hemi-resurfacing, osteotomies may be indicated in selected cases aiming to displace the affected area outside the weight bearing zone. However, considering own experiences but also data from literature, the indication for hip joint osteotomies in AVN patients should be made strict because the initial reduced blood supply of the femoral head may be affected additionaly by the surgical procedure. Moreover, it is very hard to predict the individual clinical success after femur osteotomy in AVN patients. Up to date, experimental studies and clinical trials have to show if minimal-invasive, regenerative treatment strategies will encounter a standard therapy in the treatment of AVN.

Schlüsselwörter

Hüftkopfnekrose - operative Therapie - Gelenkerhalt - Zelltherapie

Keywords

Avascular osteonecrosis - femoral head - surgery - joint preservation - cell therapy

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