Ätiologie der atraumatischen Femurkopfnekrose des Erwachsenen

 

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Zusammenfassung

Die atraumatische Femurkopfnekrose des Erwachsenen ist eine multifaktorielle Erkrankung, in deren Verlauf es zunächst zu einer lokalen Durchblutungsstörung kommt und die schließlich zu einem Einbruch des Knochens und somit einer Gelenkdestruktion führen kann. Die Hauptrisiken stellen Kortikosteroideinnahme, Alkoholabusus und renale Erkrankungen dar, die in 90 % der Fälle atraumatische Femurkopfnekrosen verursachen. Allerdings findet sich nur in seltenen Fällen lediglich ein Risikofaktor, sondern vielmehr ergibt sich bei den meisten Patienten ein Profil aus verschiedenen Risiken. Hierzu zählen Kortikosteroideinnahme und endogener Hyperkortisolismus, Alkoholabusus, Blutgerinnungsstörungen, Nikotinabusus, Hämoglobinopathien, Morbus Gaucher, HIV und andere schwere Infektionen, dysbarische Ursachen, systemischer Lupus erythematosus, Organtransplantationen, genetische Ursachen, chronisch entzündliche Darmerkrankungen, Schwangerschaft, Fettstoffwechselstörungen und Malignome. In dem vorliegenden Beitrag soll ein Überblick über die Ätiologie und Pathogenese der atraumatischen Femurkopfnekrose auf Basis der vorhandenen Literatur gegeben werden.

Summary

The non-traumatic necrosis of the femoral head in adults is a multifactorial disease, which is initiated by local disturbance of perfusion and leads finally to infraction of the femoral head and destruction of the hip joint. Major risks are corticosteroid medication, alcohol abuse and renal diseases, which cause 90 % of atraumatic necrosis of the femoral head. But there are just a few cases with just one proven risk, in most cases there is a risk profile from different risk factors for femoral head necrosis. These risk factors are corticosteroid medication and endogenous hypercortisonism, alcohol abuse, disturbances of blood coagulation, nicotine abuse, haemoglobinopathies, gaucher`s disease, HIV and severe infections, dysbaric causes, chronic inflammatory bowel disease, systemic lupus erthematosus, organ transplantation, gravidity, dyslipoproteinaemia and malignant diseases. The present article gives an overview of etiology and pathogenesis of atraumatic necrosis of the femoral head based on the current literature.

• Literatur

• 1 Asheron RA, Liote F, Page B. Avascular necrosis of bone and antiphospholipid antibodies in systemic lupus erythematosus. J Rheumatol 1993; 20: 284-288.
  Google Scholar
• 2 Barton CJ, Cockshott WP. Bone changes in haemoglobin SC disease. Am J Roentgenol 1962; 88: 523-532.
  Google Scholar
• 3 Bick RL. Disseminated intravascular coagulation. Clin Lab Med 1994; 14: 729-768.
  CrossrefGoogle Scholar
• 4 Bizot P, Nizard R, Socie G. et al. Femoral head osteonecrosis after bone marrow transplantation. Clin Orthop 1998; 357: 127-134.
  CrossrefGoogle Scholar
• 5 Bove AA. Risk of decompression sickness with patent foramen ovale. Undersea Hyper Med 1998; 25: 175-178.
  Google Scholar
• 6 Bradbury G, Benjamin J, Thompson J. et al. Avascular necrosis of bone after cardiac transplantation. J Bone Joint Surg Am 1994; 76: 1385-1388.
  CrossrefGoogle Scholar
• 7 Carvalho AC, Lees RS, Vaillancourt RA. Intravascular coagulation in hyperlipidemia. Thromb Res 1976; 08: 843-857.
  CrossrefGoogle Scholar
• 8 Cheras PA. Role of hyperlipidemia, hypercoagulability, and hypofibrinolysis in osteonecrosis and osteoarthritis. In: Urbaniak JR, Jones JP. eds. Osteonecrosis: etiology, diagnosis, and treatment. Rosemont/IL: Am Acad Orthop Surgeons; 1997: 97-104.
  Google Scholar
• 9 Colwell Jr CW, Robinson CA, Stevenson DD. et al. Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy. Orthopedics 1996; 19: 941-946.
  Google Scholar
• 10 Den Heijer M, Koster T, Blom HJ. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. N Engl J Med 1996; 334: 759-762.
  CrossrefGoogle Scholar
• 11 Doty SB, Morey-Holton ER, Durnova GN. Cosmos 1887: morphology, histochemistry, and vasculature of the growing rat tibia. FASEB 1990; 04: 16-23.
  CrossrefGoogle Scholar
• 12 Ellis J, MacLeod U, Sammon D. et al. Osteonecrosis following treatment for Hodkin`s disease. Clin Lab Haematol 1994; 16: 3-8.
  Google Scholar
• 13 Felson DT, Anderson JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet 1987; 8538: 902-905.
  Google Scholar
• 14 Garza JA. Massive fat and necrostic bone marrow embolization in a previously undiagnosed patient with sickle cell disease. Am J Forensic Med Pathol 1990; 11: 83-88.
  CrossrefGoogle Scholar
• 15 Glueck CJ, Freiberg R, Glueck HI. Hypofibrinolysis: a common, major cause of osteonecrosis. Am J Hematol 1994; 45: 156-166.
  CrossrefGoogle Scholar
• 16 Glueck CJ, Freiberg R, Gruppo R. et al. Thrombophilia and hypofibrinolysis: reversible pathogenetic etiologies of osteonecrosis. In: Rbaniak JR, Jones JP. eds. Osteonecrosis: etiology, diagnosis, and treatment. Rosemont/IL: Am Acad Orthop Surgeons; 1997: 105-110.
  Google Scholar
• 17 Glueck CJ, Fontaine RN, Gruppo R. et al. The plasminogen activator inhibitor-1 gene, hyperfibrinolysis and osteonecrosis. Clin Orthop 1999; 366: 133-146.
  CrossrefGoogle Scholar
• 18 Griffith JF, Antonio Ge, Kumta SM. et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology 2005; 235: 168-175.
  CrossrefGoogle Scholar
• 19 Hirota Y, Hirohata T, Fukuda K. et al. Association of alcohol intake, cigarette smoking, and occupational status with the risk of idiopathic osteonecrosis of the femoral head. Am J Epidemiol 1993; 137: 530-538.
  CrossrefGoogle Scholar
• 20 Hungerford DS. Pathogenetic considerations in ischemic necrosis of bone. Can J Surg 1981; 24: 583.
  Google Scholar
• 21 Jacobs B. Epidemiology of traumatic and nontraumatic osteonecrosis. Clin Orthop 1978; 130: 51-67.
  Google Scholar
• 22 Jones JP. Fat embolism and osteonecrosis. Orthop Clin North Am 1985; 16: 595-633.
  Google Scholar
• 23 Jones JP. Intravascular coagulation and osteonecrosis. Clin Orthop 1992; 277: 41-53.
  Google Scholar
• 24 Jones JP. Concepts of etiology and early pathogenesis of osteonecrosis. In: Schafer M. ed. Instructional Couse Lectures. Vol. 43. Rosemont/IL: Am Acad Orthop Surgeons; 1994: 499-512.
  Google Scholar
• 25 Jones JP. Epidemiologische Risikofaktoren für die nichttraumatische Osteonekrose. Orthopäde 2000; 29: 370-379.
  Google Scholar
• 26 Jones JP, Ramirez S, Dotzy SB. The pathophysiologic role of fat in dysbaric osteonecrosis. Clin Orthop 1993; 296: 256-264.
  Google Scholar
• 27 Koo KH, Daussault RG, Kaplan PA. et al. Fatty marrow conversion of the proximal femoral metaphysis in osteonecrotic hips. Clin Orthop 1999; 361: 159-167.
  CrossrefGoogle Scholar
• 28 Lam TH, Yau KP. Dysbaric osteonecrosis in a compressed air tunneling project in Hong Kong. Occup Med 1992; 42: 23-29.
  CrossrefGoogle Scholar
• 29 Lieberman JR, Berry DJ, Montv MA. et al. Osteonecrosis of the hip: Management in the Twenty-first Century. J Bone Joint Surg Am 2002; 84: 834-853.
  CrossrefGoogle Scholar
• 30 Marymont J, Kauffman E. Osteonecrosis of bone associated with combination chemotherapy without corticosteroids. Clin Orthop 1986; 204: 150-153.
  Google Scholar
• 31 Matsuo K, Hirohata T, Sugioka Y. et al. Influence of alchohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop 1988; 234: 115-123.
  Google Scholar
• 32 Miller KD, Masur H, Jones EC. et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 2002; 137: 17-25.
  CrossrefGoogle Scholar
• 33 Milner PF, Kraus AP, Sebes JI. Sickle cell disease as a cause of osteonecrosis of the femoral head. N Engl J Med 1991; 325: 1476-1481.
  CrossrefGoogle Scholar
• 34 Mont MA, Glueck CJ, Pacheco IH. Risk factors for osteonecrosis in systemic lupus erthematosus. J Rheumat 1997; 24: 654-662.
  Google Scholar
• 35 Mont MA, Jones LC, Hungerford DS. Current Concepts Review: Non traumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 2006; 88: 1117-1132.
  Google Scholar
• 36 Montella BJ, Nunley JA, Urbaniak JR. Osteonecrosis of the femoral head associated with pregnancy. A preliminary report. J Bone Joint Surg Am 1999; 81: 790-798.
  Google Scholar
• 37 Müller-Berghaus G. Pathophysiologic and biochemical events in disseminated intravascular coagulation: dysregulation of procoagulant and anticoagulant pathways. Sem Thromb Hemostasis 1989; 15: 58-87.
  Article in Thieme ConnectGoogle Scholar
• 38 Mullicken BD, Renfrew DL, Brand RA. Prevalence of previously undetected osteonecrosis of the femoral head in renal transplant recipients. Radiology 1994; 192: 831-834.
  CrossrefGoogle Scholar
• 39 Rico H, Gomez-Castresana F, Cabranes JA. et al. Increased blood cortisol in alcoholic patients with aseptic necrosis of the femoral head. Calcif Tissue Int 1985; 37: 585-587.
  CrossrefGoogle Scholar
• 40 Radrigue SW, Rosenthal DI, Barton NW. et al. Risk factors for osteonecrosis in patients with type I Gaucher`s disease. Clin Orthop 1999; 362: 201-207.
  Google Scholar
• 41 Scarpelli DG. Fat necrosis of bone marrow in acute pancreatitis. Am J Pathol 1956; 32: 1077-1082.
  Google Scholar
• 42 Schneiderman J, Adar R, Sawdey M. Chronic glucocorticosteroid administration modulates the response of the fibrinolytic system to bacterial lipopolysaccharide. Fibrinolysis 1994; 08: 238-244.
  Google Scholar
• 43 Solomon L. Idiopathic necrosis of the femoral head: Pathogenesis and treatment. Can J Surg 1981; 24: 573.
  Google Scholar
• 44 Solomon L. Mechanisms of idiopathic osteonecrosis. Orthop Clin North Am 1985; 16: 655-667.
  Google Scholar
• 45 Steinberg ME. Diagnostic imaging and the role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Techn Orthop 2001; 16: 6-15.
  CrossrefGoogle Scholar
• 46 Sugioka Y. Clinical and histo-pathological investigations and treatment of idiopathic necrosis of the femoral head. J Jpn Orthop Assoc 1976; 50: 1173-1186.
  Google Scholar
• 47 Vakil N, Sparberg M. Steroid-related osteonecrosis in inflammatory bowel disease. Gastroenterology 1989; 96: 62-67.
  CrossrefGoogle Scholar
• 48 Van Wersch JWJ, Westerhuis LWJJM, Venekamp WJRR. Coagulation activation in diabetes mellitus. Hemostasis 1990; 20: 263-269.
  Google Scholar
• 49 Yoo MC, Cho YJ, Lee SG. Bony lesions of professional divers in Korea. J Korean Orthop Assn 1992; 27: 331-340.
  Google Scholar
• 50 Zhang LD, Kang JF, Xue HL. Distribution of lesions in the head and neck of the humerus and the femur in dysbaric osteonecrosis. Biomed Res 1990; 17: 353-358.
  Google Scholar