Ätiologie der atraumatischen Femurkopfnekrose des Erwachsenen

Zusammenfassung

Die atraumatische Femurkopfnekrose des Erwachsenen ist eine multifaktorielle Erkrankung, in deren Verlauf es zunächst zu einer lokalen Durchblutungsstörung kommt und die schließlich zu einem Einbruch des Knochens und somit einer Gelenkdestruktion führen kann. Die Hauptrisiken stellen Kortikosteroideinnahme, Alkoholabusus und renale Erkrankungen dar, die in 90 % der Fälle atraumatische Femurkopfnekrosen verursachen. Allerdings findet sich nur in seltenen Fällen lediglich ein Risikofaktor, sondern vielmehr ergibt sich bei den meisten Patienten ein Profil aus verschiedenen Risiken. Hierzu zählen Kortikosteroideinnahme und endogener Hyperkortisolismus, Alkoholabusus, Blutgerinnungsstörungen, Nikotinabusus, Hämoglobinopathien, Morbus Gaucher, HIV und andere schwere Infektionen, dysbarische Ursachen, systemischer Lupus erythematosus, Organtransplantationen, genetische Ursachen, chronisch entzündliche Darmerkrankungen, Schwangerschaft, Fettstoffwechselstörungen und Malignome. In dem vorliegenden Beitrag soll ein Überblick über die Ätiologie und Pathogenese der atraumatischen Femurkopfnekrose auf Basis der vorhandenen Literatur gegeben werden.

Summary

The non-traumatic necrosis of the femoral head in adults is a multifactorial disease, which is initiated by local disturbance of perfusion and leads finally to infraction of the femoral head and destruction of the hip joint. Major risks are corticosteroid medication, alcohol abuse and renal diseases, which cause 90 % of atraumatic necrosis of the femoral head. But there are just a few cases with just one proven risk, in most cases there is a risk profile from different risk factors for femoral head necrosis. These risk factors are corticosteroid medication and endogenous hypercortisonism, alcohol abuse, disturbances of blood coagulation, nicotine abuse, haemoglobinopathies, gaucher`s disease, HIV and severe infections, dysbaric causes, chronic inflammatory bowel disease, systemic lupus erthematosus, organ transplantation, gravidity, dyslipoproteinaemia and malignant diseases. The present article gives an overview of etiology and pathogenesis of atraumatic necrosis of the femoral head based on the current literature.

Schlüsselwörter

Atraumatische Femurkopfnekrose - Gelenkdestruktion

Keywords

Atraumatic femoral head necrosis - destruction of the hip joint

• Literatur

• 1 Asheron RA, Liote F, Page B. Avascular necrosis of bone and antiphospholipid antibodies in systemic lupus erythematosus. J Rheumatol 1993; 20: 284-288.
• 2 Barton CJ, Cockshott WP. Bone changes in haemoglobin SC disease. Am J Roentgenol 1962; 88: 523-532.
• 3 Bick RL. Disseminated intravascular coagulation. Clin Lab Med 1994; 14: 729-768.
• 4 Bizot P, Nizard R, Socie G. et al. Femoral head osteonecrosis after bone marrow transplantation. Clin Orthop 1998; 357: 127-134.
• 5 Bove AA. Risk of decompression sickness with patent foramen ovale. Undersea Hyper Med 1998; 25: 175-178.
• 6 Bradbury G, Benjamin J, Thompson J. et al. Avascular necrosis of bone after cardiac transplantation. J Bone Joint Surg Am 1994; 76: 1385-1388.
• 7 Carvalho AC, Lees RS, Vaillancourt RA. Intravascular coagulation in hyperlipidemia. Thromb Res 1976; 08: 843-857.
• 8 Cheras PA. Role of hyperlipidemia, hypercoagulability, and hypofibrinolysis in osteonecrosis and osteoarthritis. In: Urbaniak JR, Jones JP. eds. Osteonecrosis: etiology, diagnosis, and treatment. Rosemont/IL: Am Acad Orthop Surgeons; 1997: 97-104.
• 9 Colwell Jr CW, Robinson CA, Stevenson DD. et al. Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy. Orthopedics 1996; 19: 941-946.
• 10 Den Heijer M, Koster T, Blom HJ. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. N Engl J Med 1996; 334: 759-762.
• 11 Doty SB, Morey-Holton ER, Durnova GN. Cosmos 1887: morphology, histochemistry, and vasculature of the growing rat tibia. FASEB 1990; 04: 16-23.
• 12 Ellis J, MacLeod U, Sammon D. et al. Osteonecrosis following treatment for Hodkin`s disease. Clin Lab Haematol 1994; 16: 3-8.
• 13 Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet 1987; 8538: 902-905.
• 14 Garza JA. Massive fat and necrostic bone marrow embolization in a previously undiagnosed patient with sickle cell disease. Am J Forensic Med Pathol 1990; 11: 83-88.
• 15 Glueck CJ, Freiberg R, Glueck HI. Hypofibrinolysis: a common, major cause of osteonecrosis. Am J Hematol 1994; 45: 156-166.
• 16 Glueck CJ, Freiberg R, Gruppo R. et al. Thrombophilia and hypofibrinolysis: reversible pathogenetic etiologies of osteonecrosis. In: Rbaniak JR, Jones JP. eds. Osteonecrosis: etiology, diagnosis, and treatment. Rosemont/IL: Am Acad Orthop Surgeons; 1997: 105-110.
• 17 Glueck CJ, Fontaine RN, Gruppo R. et al. The plasminogen activator inhibitor-1 gene, hyperfibrinolysis and osteonecrosis. Clin Orthop 1999; 366: 133-146.
• 18 Griffith JF, Antonio Ge, Kumta SM. et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology 2005; 235: 168-175.
• 19 Hirota Y, Hirohata T, Fukuda K. et al. Association of alcohol intake, cigarette smoking, and occupational status with the risk of idiopathic osteonecrosis of the femoral head. Am J Epidemiol 1993; 137: 530-538.
• 20 Hungerford DS. Pathogenetic considerations in ischemic necrosis of bone. Can J Surg 1981; 24: 583.
• 21 Jacobs B. Epidemiology of traumatic and nontraumatic osteonecrosis. Clin Orthop 1978; 130: 51-67.
• 22 Jones JP. Fat embolism and osteonecrosis. Orthop Clin North Am 1985; 16: 595-633.
• 23 Jones JP. Intravascular coagulation and osteonecrosis. Clin Orthop 1992; 277: 41-53.
• 24 Jones JP. Concepts of etiology and early pathogenesis of osteonecrosis. In: Schafer M. ed. Instructional Couse Lectures. Vol. 43. Rosemont/IL: Am Acad Orthop Surgeons; 1994: 499-512.
• 25 Jones JP. Epidemiologische Risikofaktoren für die nichttraumatische Osteonekrose. Orthopäde 2000; 29: 370-379.
• 26 Jones JP, Ramirez S, Dotzy SB. The pathophysiologic role of fat in dysbaric osteonecrosis. Clin Orthop 1993; 296: 256-264.
• 27 Koo KH, Daussault RG, Kaplan PA. et al. Fatty marrow conversion of the proximal femoral metaphysis in osteonecrotic hips. Clin Orthop 1999; 361: 159-167.
• 28 Lam TH, Yau KP. Dysbaric osteonecrosis in a compressed air tunneling project in Hong Kong. Occup Med 1992; 42: 23-29.
• 29 Lieberman JR, Berry DJ, Montv MA. et al. Osteonecrosis of the hip: Management in the Twenty-first Century. J Bone Joint Surg Am 2002; 84: 834-853.
• 30 Marymont J, Kauffman E. Osteonecrosis of bone associated with combination chemotherapy without corticosteroids. Clin Orthop 1986; 204: 150-153.
• 31 Matsuo K, Hirohata T, Sugioka Y. et al. Influence of alchohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop 1988; 234: 115-123.
• 32 Miller KD, Masur H, Jones EC. et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 2002; 137: 17-25.
• 33 Milner PF, Kraus AP, Sebes JI. Sickle cell disease as a cause of osteonecrosis of the femoral head. N Engl J Med 1991; 325: 1476-1481.
• 34 Mont MA, Glueck CJ, Pacheco IH. Risk factors for osteonecrosis in systemic lupus erthematosus. J Rheumat 1997; 24: 654-662.
• 35 Mont MA, Jones LC, Hungerford DS. Current Concepts Review: Non traumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 2006; 88: 1117-1132.
• 36 Montella BJ, Nunley JA, Urbaniak JR. Osteonecrosis of the femoral head associated with pregnancy. A preliminary report. J Bone Joint Surg Am 1999; 81: 790-798.
• 37 Müller-Berghaus G. Pathophysiologic and biochemical events in disseminated intravascular coagulation: dysregulation of procoagulant and anticoagulant pathways. Sem Thromb Hemostasis 1989; 15: 58-87.
• 38 Mullicken BD, Renfrew DL, Brand RA. Prevalence of previously undetected osteonecrosis of the femoral head in renal transplant recipients. Radiology 1994; 192: 831-834.
• 39 Rico H, Gomez-Castresana F, Cabranes JA. et al. Increased blood cortisol in alcoholic patients with aseptic necrosis of the femoral head. Calcif Tissue Int 1985; 37: 585-587.
• 40 Radrigue SW, Rosenthal DI, Barton NW. et al. Risk factors for osteonecrosis in patients with type I Gaucher`s disease. Clin Orthop 1999; 362: 201-207.
• 41 Scarpelli DG. Fat necrosis of bone marrow in acute pancreatitis. Am J Pathol 1956; 32: 1077-1082.
• 42 Schneiderman J, Adar R, Sawdey M. Chronic glucocorticosteroid administration modulates the response of the fibrinolytic system to bacterial lipopolysaccharide. Fibrinolysis 1994; 08: 238-244.
• 43 Solomon L. Idiopathic necrosis of the femoral head: Pathogenesis and treatment. Can J Surg 1981; 24: 573.
• 44 Solomon L. Mechanisms of idiopathic osteonecrosis. Orthop Clin North Am 1985; 16: 655-667.
• 45 Steinberg ME. Diagnostic imaging and the role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Techn Orthop 2001; 16: 6-15.
• 46 Sugioka Y. Clinical and histo-pathological investigations and treatment of idiopathic necrosis of the femoral head. J Jpn Orthop Assoc 1976; 50: 1173-1186.
• 47 Vakil N, Sparberg M. Steroid-related osteonecrosis in inflammatory bowel disease. Gastroenterology 1989; 96: 62-67.
• 48 Van Wersch JWJ, Westerhuis LWJJM, Venekamp WJRR. Coagulation activation in diabetes mellitus. Hemostasis 1990; 20: 263-269.
• 49 Yoo MC, Cho YJ, Lee SG. Bony lesions of professional divers in Korea. J Korean Orthop Assn 1992; 27: 331-340.
• 50 Zhang LD, Kang JF, Xue HL. Distribution of lesions in the head and neck of the humerus and the femur in dysbaric osteonecrosis. Biomed Res 1990; 17: 353-358.