Zukünftige Strategien zur Therapie der atraumatischen Femurkopfnekrose

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

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