Die Therapie der Osteonekrose des Femurkopfes: Ergebnisse einer bundesweiten Umfrage

Zusammenfassung

Studienziel: Die Therapie der Hüftkopfnekrose (HKN) wird in der Literatur kontrovers diskutiert. Ziel dieser Studie ist es, die an orthopädischen Kliniken in Deutschland angewandten Therapiekonzepte zur Behandlung der HKN zu erfassen und mit den Empfehlungen in der Literatur zu vergleichen. Methode: 219 orthopädische Kliniken wurde mittels eines standardisierten und anonymen Fragebogens zur Ätiologie, bildgebenden Diagnostik und Therapie der HKN (konservativ, operativ) befragt. Es erfolgte eine univariante Analyse der Daten mit Bestimmung von Häufigkeiten, Durchschnitts- und Medianwerten. Ergebnisse: 43 % der HKNs wurden als idiopathisch klassifiziert, Alkoholabusus (28 %) und Steroideinnahme (17 %) galten als weitere Ursachen. 100 % der Kliniken führen ein Standardröntgen in zwei Ebenen durch, 78 % darüber hinaus eine Kernspintomographie. In frühen Stadien der HKN (I, II) erfolgt in 33 % der Kliniken eine konservative Therapie (Entlastung, Stoßwelle, Magnetfeld), 67 % bevorzugen eine operative Therapie (79 % Dekompression, 15 % Umstellung, 6 % Endoprothese). In fortgeschrittenen Stadien (III, IV) führen 97 % der Kliniken eine Operation durch (11 % Dekompression, 10 % Umstellung, 79 % Endoprothese). Schlussfolgerung: Die alleinige Entlastung zeigt unbefriedigende Verläufe. Mittelfristige Ergebnisse neuer konservativer Methoden (Stoßwelle, Magnetfeld) stehen noch aus. Im Frühstadium gilt die operative Dekompression als etabliertes Verfahren. Der endoprothetische Gelenkersatz stellt das Verfahren der Wahl bei der fortgeschrittenen HKN mit sekundärer Coxarthrose dar.

Abstract

Aim: The therapy for osteonecrosis (ON) of the femoral head is controversially discussed in the literature. The aim of this study was to ascertain the current treatment concepts of ON in Germany and to compare them with the results reported in the literature. Methods: 219 Departments of Orthopedic Surgery were asked for their treatment strategies in an anonymous country-wide survey regarding the etiology, diagnosis and therapy (conservative, operative) of ON. Univariate analyses were performed and means, medians and rates were calculated. Results: 43 % of ON were idiopathic, 28 % were due to alcoholism and another 17 % were seen after steroid intake. All departments performed biplanar X-rays for diagnosis of ON and 78 % of departments obtained additional magnet resonance imaging. In the early stages of ON (stage I, II) 33 % of orthopedic clinics recommend a conservative treatment (protected weight bearing, high energy shock wave, pulsed electromagnetic fields) while 67 % prefer surgery (79 % core decompression, 15 % flexion osteotomy, 6 % total hip arthroplasty). In the later stages (stage III, IV) most clinics perform an operative treatment (11 % core decompression, 10 % flexion osteotomy, 79 % total hip arthroplasty). Conclusion: Results of ON of the femoral head are unsatisfactory after protected weight bearing. No randomized clinical trials and no mid-term results are available for high energy shock wave or pulsed electromagnetic fields therapy. In the early stages of ON core decompression shows good results. However, in he later stages with secondary arthritis of the hip, total hip arthroplasty remains the gold standard.

Schlüsselwörter

Hüftkopfnekrose - konservative Therapie - Anbohrung - Gelenkersatz

Key words

Osteonecrosis of the femoral head - conservative treatment - core decompression - total hip arthroplasty

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