Conservative treatment of atraumatic femoral head necrosis

• Published in: Der Orthopäde Vol. 47; no. 9; pp. 735 - 744
• Main Authors: Maus, U, Flechtenmacher, J, Peters, K M
• Format: Journal Article
• Language: German
• Published: Germany 01.09.2018
• Subjects: Conservative Treatment; Femur Head; Femur Head Necrosis - therapy; Humans; Electric stimulation therapy; Iloprost; Bisphosphonates; High-energy shock waves; Femur head
• ISSN: 1433-0431
• DOI: 10.1007/s00132-018-3616-6

Femoral head necrosis is a progressive disease that can progress within a relatively short time. Therefore, an early and clear diagnosis including stage classification and treatment is necessary to prevent or delay the onset of the femoral head and joint destruction. In addition to the identification of possible risk factors and treatment, the question of the available treatment options arises. The present article deals with conservative treatment options and presents the published results in the sense of the currently available evidence and against the background of the S3 guideline on atraumatic femoral head necrosis. The results of physical therapy, drug therapy (iloprost and bisphosphonates ), electrotherapy, shockwave therapy, etc. are presented. In the early stages of femoral head necrosis with low expansion, alendronate gives positive results. Iloprost is also a successful conservative treatment option in the early stages of atraumatic femoral head necrosis (ARCO I and II). In stages ARCO III and IV, Ilomedin is no longer indicated. Anticoagulants, such as enoxaparin, have demonstrated an arthroprotective effect.