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Arthritis und Rheuma 2021; 41(04): 259-264
DOI: 10.1055/a-1523-6771
Schwerpunkt

Operative Interventionen beim Knochenmarködem und bei Osteonekrose

Surgical procedures for the management of bone marrow edema and osteonecrosis
Andreas Roth∗
1   Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Uniklinik Leipzig AöR
,
Jeanette Henkelmann∗
2   Klinik für Diagnostische und Interventionelle Radiologie, Uniklinik Leipzig AöR
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ZUSAMMENFASSUNG

Das transitorische Knochenmarködem (KMÖ) stellt eine klinisch schmerzhafte, ätiologisch weiterhin nicht gänzlich geklärte Krankheitsentität dar und grenzt sich vom Frühstadium einer Osteonekrose ab. Sie betrifft am häufigsten das Hüft- und Kniegelenk und ist in der Regel mit einer guten Prognose selbstlimitierend. Die initiale Behandlung des KMÖ ist konservativ und beinhaltet neben einer Entlastung der Körperregion medikamentöse Therapien. Eine chirurgische Intervention mittels retrograder Anbohrung zur Druckentlastung bleibt Patienten mit starken, schwer kontrollierbaren Schmerzen vorbehalten. Osteonekrosen erfordern ein abgestuftes therapeutisches Vorgehen und richten sich am Stadium der Osteonekrose und der sekundären Gelenkschäden aus. Eine frühzeitige Diagnose bzw. frühe Stadien und Therapie sowie kleine Läsionsgrößen weisen bessere Prognosen auf. Unbehandelt führt sie zur Arthrose. In der Mehrzahl der Fälle ist eine chirurgische Intervention erforderlich, welche gelenkerhaltende Maßnahmen wie die Entlastungsbohrung und osteochondrale Autografts umfassen. Vor allem im Spätstadium müssen endoprothetische Verfahren erwogen werden.

SUMMARY

Transient bone marrow edema (BME) is clinically characterized by pain. The etiology is still not fully understood, but it does not represent an early stage of osteonecrosis. It most commonly affects the hip and knee joints and is usually self-limiting with a good prognosis. Initial treatment of BME is conservative and includes non-weight-bearing and drug therapies. Surgical intervention by retrograde core decompression aimed at pressure reduction is limited to patients with severe pain. Osteonecrosis requires a graded therapeutic approach and is based on the stage of osteonecrosis and secondary joint destruction. Early diagnosis respective early stages and therapy along with small lesion sizes have better prognoses. If left untreated, it leads to osteoarthritis. Surgical intervention is usually required, which includes joint-preserving procedures such as core decompression and osteochondrale grafts. Endoprosthetic procedures must be considered, especially in the late stages.

Schlüsselwörter

Knochenmarködem - Osteonekrose - Morbus Ahlbäck - Entlastungsbohrung - Core Decompression - Endoprothese

Keywords

Bone marrow edema - osteonecrosis - Ahlbäck´s disease - core decompression - endoprosthesis


Publication History

Article published online:
19 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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