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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

01.02.2016 | Orthopaedic Surgery

S3-Guideline non-traumatic adult femoral head necrosis

verfasst von: A. Roth, J. Beckmann, K. Bohndorf, A. Fischer, C. Heiß, W. Kenn, M. Jäger, U. Maus, U. Nöth, K. M. Peters, C. Rader, S. Reppenhagen, U. Smolenski, M. Tingart, I. Kopp, I. Sirotin, S. J. Breusch

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 2/2016

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Abstract

Introduction

The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000–7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management. In this review, we present the update German consensus S3 guideline “diagnosis and management for N-ANFH” as a concise summary.

Materials and methods

This systematic review is based on the published literature from January 1, 1970 to April 31, 2013 (German and English language). Inclusion criteria were systematic reviews, meta-analyses and relevant peer review publications. We identified a total of 3715 related publications, of which 422 were suitable according to the SIGN criteria, but only 159 fulfilled our inclusion criteria.

Results and conclusions

Clinical suspicion of N-ANFH mandates radiographic evaluation. If radiographs are normal MRI scans are recommended, which should be evaluated according to the ARCO-classification. Differential diagnoses include transient osteoporosis, bone bruise, insufficiency fracture and destructive arthropathy. Untreated, subchondral fractures commonly occur within 2 years, during which the risk for contralateral involvement is high—thereafter unlikely. Conservative management with Ilomedin and Alendronat can be tried, but other pharmacological or physical treatments are inappropriate. No specific joint preserving procedure can be recommended, but core decompression should be considered in early stages if necrosis is <30 %. In ARCO stages IIIc or IV total hip arthroplasty (THA) should be contemplated, which offers similar outcome compared to osteoarthritis. Young age is the main risk factor for higher revision rates after THA for N-ANFH.

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Titel: S3-Guideline non-traumatic adult femoral head necrosis
verfasst von: A. Roth
J. Beckmann
K. Bohndorf
A. Fischer
C. Heiß
W. Kenn
M. Jäger
U. Maus
U. Nöth
K. M. Peters
C. Rader
S. Reppenhagen
U. Smolenski
M. Tingart
I. Kopp
I. Sirotin
S. J. Breusch
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 2/2016
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2375-7

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