Download PDF
Osteologie 2010; 19(01): 53-59
DOI: 10.1055/s-0037-1619925
Atraumatische Femurkopfnekrose des Erwachsenen
Schattauer GmbH

Zukünftige Strategien zur Therapie der atraumatischen Femurkopfnekrose

Future strategies for the treatment of atraumatic femoral head necrosis
U. Nöth
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
S. Reppenhagen
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
A. Steinert
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
F. Jakob
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
J. Reichert
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
M. Rudert
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
,
L. Rackwitz
1   Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg
› Author Affiliations
Further Information

Publication History

eingereicht: 02 February 2010

angenommen: 10 February 2010

Publication Date:
30 December 2017 (online)

    Permissions and Reprints

Zusammenfassung

Die atraumatische Femurkopfnekrose in einem frühen Stadium (ARCO-Stadium I und II) mit erhaltener struktureller Integrität der subchondralen Lamelle erlaubt retrograde operative Verfahren, wie die Core Decompression, um ein knöchernes Remodeling des nekrotischen Areals zu induzieren. Die zusätzliche Applikation von Knochenmarkaspiraten, ex vivo expandierten Knochenmarkstammzellen sowie osteogenen oder angiogenen Wachstumsfaktoren hat das Potenzial, eine verbesserte knöcherne Regeneration zu erreichen. Hingegen bedarf die Therapie der fortgeschrittenen Femurkopfnekrose mit Einbruch der subchondralen Lamelle (ARCO-Stadium III) einem anterograden Verfahren, um die physiologische Gelenkfunktion ohne den Einsatz endoprothetischer Verfahren wiederherzustellen. Analog zur osteochondralen Rekonstruktion am Kniegelenk könnte mit der Transplantation von autologen osteochondralen Zylindern oder der matrixbasierten autologen Chondrozyten Transplantation die Gelenkfunktion möglicherweise zukünftig erhalten bleiben.

Summary

Early stages of atraumatic femoral head necrosis (ARCO stage I and II) with preserved structural integrity of the subchondral plate are accessible for retrograde conducted surgical procedures, such as core decompression, to induce bone remodelling. The additive application of bone marrow aspirates, ex vivo expanded bone marrow stem cells, as well as osteogenic or angiogenic growth factors has the potential to improve bone regeneration. Whereas, advanced stages of atraumatic femoral head necrosis with a collapsed subchondral plate (ARCO stage III) require an osteochondral reconstruction to preserve the physiological joint function without the need of total joint replacement. In analogy to strategies for osteochondral reconstruction in the knee joint, transplantation of autologous osteochondral cylinders or matrix-based autologous chondrocyte transplantation, might preserve the joint function in the future.

Schlüsselwörter

Hüftkopfnekrose - Stammzellen - Wachstumsfaktoren - osteochondrale Transplantation - autologe Chondrozyten Transplantation (ACT)

Keywords

Femoral head necrosis - stem cells - growth factors - osteochondral transplantation - autologous chondrocyte transplantation (ACT)
 

  • Literatur

  • 1 Akimau P, Bhosale A, Harrison PE. et al. Autologous chondrocyte implantation with bone grafting for osteochondral defect due to posttraumatic osteonecrosis of the hip – a case report. Acta Orthop 2006; 77: 333-336.
    CrossrefPubMedGoogle Scholar
  • 2 Baksh D, Song L, Tuan RS. Adult mesenchymal stem cells: characterization, differentiation, and application in cell and gene therapy. J Cell Mol Med 2004; 08: 301-316.
    CrossrefPubMedGoogle Scholar
  • 3 Brunt KR, Hall SR, Ward CA, Melo LG. Endothelial progenitor cell and mesenchymal stem cell isolation, characterization, viral transduction. Methods Mol Med 2007; 139: 197-210.
    PubMedGoogle Scholar
  • 4 Caplan AI, Dennis JE. Mesenchymal Stem Cells as Trophic Mediators. J Cell Biochem 2006; 98: 1076-1084.
    CrossrefPubMedGoogle Scholar
  • 5 Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev 2004; 25: 581-611.
    CrossrefPubMedGoogle Scholar
  • 6 Gangji V, Hauzeur JP. Treatment of Osteonecrosis of the Femoral Head with Implantation of Autologous Bone-Marrow Cells. Surgical technique. J Bone Joint Surg Am 2005; 07 (Suppl. 01) 106-112.
    Google Scholar
  • 7 Gherardi E, Stoker M. Hepatocytes and scatter factor. Nature 1990; 346: 228.
    PubMedGoogle Scholar
  • 8 Gruber R, Mayer C, Schulz W. et al. Stimulatory effects of cartilage-derived morphogenetic proteins 1 and 2 on osteogenic differentiation of bone marrow stromal cells. Cytokine 2000; 12: 1630-1638.
    CrossrefPubMedGoogle Scholar
  • 9 Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 2002; 405: 14-23.
    CrossrefPubMedGoogle Scholar
  • 10 Hernigou P, Manicom O, Poignard A. et al. Core decompression with marrow stem cells. Operative Tech Orthop 2004; 14: 68-74.
    CrossrefGoogle Scholar
  • 11 Hernigou P, Poignard A, Manicom O. et al. The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Joint Surg Br 2005; 78: 896-902.
    Google Scholar
  • 12 Kawate K, Yajima H, Ohgushi H. et al. Tissue-engineered approach for the treatment of steroid-induced osteonecrosis of the femoral head: transplantation of autologous mesenchymal stem cells cultured with beta-tricalcium phosphate ceramics and free vascularized fibula. Artif Organs 2006; 30: 960-962.
    CrossrefPubMedGoogle Scholar
  • 13 Lieberman JR. Core decompression for osteonecrosis of the hip. Clin Orthop Relat Res 2004; 418: 29-33.
    CrossrefPubMedGoogle Scholar
  • 14 Lieberman JR, Berry DJ, Mont MA. et al. Osteonecrosis of the hip: management in the 21st century. J Bone Joint Surg 2002; 84: 834-853.
    CrossrefGoogle Scholar
  • 15 Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res 2004; 429: 139-145.
    CrossrefPubMedGoogle Scholar
  • 16 Meyers MH. Resurfacing of the femoral head with fresh osteochondral allografts. Long-term results. Clin Orthop Relat Res 1985; 197: 111-114.
    Google Scholar
  • 17 Meyers MH, Jones RE, Bucholz RW, Wenger DR. Fresh autogenous grafts and osteochondral allografts for the treatment of segmental collapse in osteonecrosis of the hip. Clin Orthop Relat Res 1983; 174: 107-112.
    Google Scholar
  • 18 Mont MA, Einhorn TA, Sponseller PD, Hungerford DS. The trapdoor procedure using autogenous cortical and cancellous bone grafts for osteonecrosis of the femoral head. J Bone Joint Surg Br 1998; 80: 56-62.
    CrossrefPubMedGoogle Scholar
  • 19 Mont MA, Etienne G, Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 2003; 417: 84-92.
    Google Scholar
  • 20 Mont MA, Jones LC, Einhorn TA. et al. Osteonecrosis of the femoral head. Potential treatment with growth and differentiation factors. Clin Orthop 1998; 355 (Suppl): 314-335.
    Google Scholar
  • 21 Mont MA, Jones LC, Elias JJ. et al. Strut-autografting with and without osteogenic protein-1: a preliminary study of a canine femoral head defect model. J Bone Joint Surg Am 2001; 83: 1013-1022.
    CrossrefPubMedGoogle Scholar
  • 22 Mont MA, Jones LC, Seyler TM. et al. New treatment approaches for osteonecrosis of the femoral head: an overview. Instr Course Lect 2007; 56: 197-212.
    PubMedGoogle Scholar
  • 23 Müller I, Vaegler M, Holzwarth C. et al. Secretion of angiogenic proteins by human multipotent mesenchymal stromal cells and their clinical potential in the treatment of avascular osteonecrosis. Leukemia 2008; 22: 2054-2061.
    CrossrefPubMedGoogle Scholar
  • 24 Nöth U, Reichert J, Reppenhagen S. et al. Zellbasierte Therapie der Femurkopfnekrose. Orthopäde 2007; 36: 466-471.
    CrossrefPubMedGoogle Scholar
  • 25 Reddi AH. Cartilage morphogenetic proteins: role in joint development, homoeostasis, and regeneration. Ann Rheum Dis 2003; 62 (Suppl. 02) 73-78.
    Google Scholar
  • 26 Rittmeister M, Hochmuth K, Kriener S, Richolt J. Five-year results following autogenous osteochondral transplantation to the femoral head. Orthopäde 2005; 34: 320-322.
    CrossrefPubMedGoogle Scholar
  • 27 Seyler TM, Cui Q, Mihalko WM. et al. Advances in hip arthroplasty in the treatment of osteonecrosis. Instr Course Lect 2007; 56: 221-233.
    PubMedGoogle Scholar
  • 28 Seyler TM, Marker DR, Ulrich SD. et al. Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis. Clin Orthop Relat Res 2008; 466: 1125-1132.
    CrossrefPubMedGoogle Scholar
  • 29 Simank HG, Herold F, Schneider M. et al. Das Wachstumsfaktorkomposit aus GDF-5 und mineralisiertem Kollagen verbessert die Ausheilung einer Hüftkopfnekrose. Orthopäde 2004; 33: 68-75.
    CrossrefPubMedGoogle Scholar
  • 30 Simank HG, Manggold J, Sebald W. et al. Bone morphogenetic protein-2 and growth and differentiation factor-5 enhance the healing of necrotic bone in a sheep model. Growth Factors 2001; 19: 247-257.
    CrossrefPubMedGoogle Scholar
  • 31 Sotereanos NG, DeMeo PJ, Hughes TB. et al. Autogenous osteochondral transfer in the femoral head after osteonecrosis. Orthopedics 2008; 31: 177.
    PubMedGoogle Scholar
  • 32 Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995; 77: 34-41.
    CrossrefPubMedGoogle Scholar
  • 33 Tang TT, Lu B, Yue B. et al. Treatment of osteonecrosis of the femoral head with hBMP-2-gene-modified tissue-engineered bone in goats. J Bone Joint Surg Br 2007; 89: 127-129.
    PubMedGoogle Scholar
  • 34 Tönjes RR, Scherer J, Cichutek K. Regelungen des Gewebegesetzes für klassische Gewebezubereitungen und Stand der Genehmigungsverfahren gemäß § 21a Arzneimittelgesetz. In: Pühler W, Middel C-D, Hübner M. Hrsg. Praxisleitfaden Gewebegesetz. Köln: Deutscher Ärzte-Verlag; 2008: 161-175.
    Google Scholar
  • 35 Toth ZE, Leker RR, Shahar T. et al. The combination of granulocyte colony-stimulating factor and stem cell factor significantly increases the number of bone marrow-derived endothelial cells in brains of mice following cerebral ischemia. Blood 2008; 111: 5544-5552.
    CrossrefPubMedGoogle Scholar
  • 36 Tsumaki N, Tanaka K, Arikawa-Hirasawa E. et al. Role of CDMP-1 in skeletal morphogenesis: promotion of mesenchymal cell recruitment and chondrocyte differentiation. J Cell Biol 1999; 144: 161-173.
    CrossrefPubMedGoogle Scholar
  • 37 Wen Q, Ma L, Chen YP. et al. Treatment of avascular necrosis of the femoral head by hepatocyte growth factor-transgenic bone marrow stromal stem cells. Gene Ther 2008; 15: 1523-1535.
    CrossrefPubMedGoogle Scholar
  • 38 Wu X, Yang S, Duan D. et al. A combination of granulocyte colony-stimulating factor and stem cell factor ameliorates steroid-associated osteonecrosis in rabbits. J Rheumatol 2008; 35: 2241-2248.
    CrossrefPubMedGoogle Scholar
  • 39 Yan Z, Hang D, Guo C, Chen Z. Fate of mesenchymal stem cells transplanted to osteonecrosis of femoral head. J Orthop Res 2009; 27: 442-446.
    CrossrefPubMedGoogle Scholar
  • 40 Yang C, Yang S, Du J. et al. Vascular endothelial growth factor gene transfection to enhance the repair of avascular necrosis of the femoral head of rabbit. Chin Med J (Engl) 2003; 116: 1544-1548.
    Google Scholar