Pathophysiology and Current Treatment Concepts for Selected Examples of Osteonecrosis Pathophysiologie und aktuelle Behandlungskonzepte bei ausgewählten Osteonekrosen
Gatz M, Betsch M, Andruszkow J, Quack V, Tingart M (2020)
Publication Type: Journal article
Publication year: 2020
Journal
Book Volume: 45
Pages Range: 86-95
Journal Issue: 1
DOI: 10.1055/a-1016-3183
Abstract
Osteonecrosis occurs in both children and adults with the main focus on the epiphysis as a predisposed location. Pathophysiologically, a distinction is made between primary vascular (thromboembolism, haemoglobinopathy etc.), toxic (alcohol, cortisone, chemotherapeutic agents) and idiopathic origin. Independently of the aetiology, osteonecrosis leads to necrosis of the bone trabeculae and the adjacent bone marrow as well as oedema formation. Avascular remodelling causes fibrosis and the formation of mechanically unstable woven bone, leading to a subchrondral fracture and a collapse of the joint surface. Especially if large joints are involved, secondary osteoarthritic deformities occur, so femoral head necrosis, focal subchondral osteonecrosis and osteochondrosis dissecans of the knee are of clinical significance. X-ray and MRI are crucial diagnostic procedures. The treatment of osteonecrosis is challenging. For conservative therapy, the off-label use of peripheral vasodilators and bisphosphonates may reduce pain and time to articular collapse, whereas hyperbaric oxygen therapy, shockwave therapy, anticoagulants and statins are not recommended. Standard treatment in early stages focuses on retrograde drilling aimed at reducing oedema and breaking down the sclerosis zone to establish a process of revascularisation. Further operative options such as corrective osteotomies, vascularized bone grafts and cartilage remodelling surgery are possible, but they compete with prosthetic joint replacement and are inferior, especially in progressive stages.
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Germany (DE)How to cite
APA:
Gatz, M., Betsch, M., Andruszkow, J., Quack, V., & Tingart, M. (2020). Pathophysiology and Current Treatment Concepts for Selected Examples of Osteonecrosis Pathophysiologie und aktuelle Behandlungskonzepte bei ausgewählten Osteonekrosen. Aktuelle Rheumatologie, 45(1), 86-95. https://dx.doi.org/10.1055/a-1016-3183
MLA:
Gatz, Matthias, et al. "Pathophysiology and Current Treatment Concepts for Selected Examples of Osteonecrosis Pathophysiologie und aktuelle Behandlungskonzepte bei ausgewählten Osteonekrosen." Aktuelle Rheumatologie 45.1 (2020): 86-95.
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