2. operative therapy: | Therapy of femoral head necrosis

2. operative therapy:

Surgical therapies are particularly dependent on the stage of the disease, so to speak on the extent of necrosis. After the different surgical procedures have been presented, the therapy possibilities of the different stages will be discussed.

  • Etiology/cause of femoral head necrosis, stage of the disease, extent of necrosis
  • Age, general condition, concomitant diseases
  • Patient compliance (patient motivation)

A distinction is made between the procedures listed below:: 1. joint-preserving operations a) Medullary decompression, chip plastic: Medullary decompression with possibly chip plastic is used in the early stages of femoral head necrosis, as the probability of success of this surgical method decreases in more advanced stages.

This type of surgery serves to decompress the medullary cavity and also provides mechanical support for the necrosis site. During the operation, an attempt can also be made to stimulate the formation of new vessels by drilling into the femoral head. As the chances of success depend on the individual clinical picture, it is not possible to make a prognosis regarding the probability of success.

  • Joint preserving operations Medullary decompression, possibly with chip plastic Intertrochanteric osteotomy
  • Medullary decompression, possibly with chip plastic
  • Intertrochanteric osteotomy
  • Joint replacement endoprosthesis
  • Endoprosthesis
  • Medullary decompression, possibly with chip plastic
  • Intertrochanteric osteotomy
  • Endoprosthesis

The femoral head cannulation is a small surgical procedure in which the affected femoral head is drilled. This treatment method is only used in the first or second stage of femoral head necrosis. A small canal is created in the femoral head through the drilling.

The aim is to allow it to bleed into the canal and form new vessels. You can walk again on the day of the femoral head cannulation, but initially only with crutches. The affected hip is completely relieved for about six weeks after a femoral head cannulation.

After six weeks, the doctor examines the hip and evaluates the success of the operation. On average, the hip may be completely loaded again after six to ten weeks, so that one may then walk without forearm crutches. A repositioning osteotomy is a surgical procedure that can be used in the second and third stage of femoral head necrosis.

The treating surgeon removes necrotized tissue from the femoral head and adjusts the position of the femoral head in the joint. Bone is cut through and fixed with metal implants. The use of a hip prosthesis is a treatment method for advanced femoral head necrosis.

It is considered to be the last resort (last resort) of treatment options. If the affected femoral head is progressively necrotized, a fracture occurs in the course of the disease. At the latest when the femoral head has collapsed, a hip prosthesis (hip-TEP) is necessary to maintain the joint function.

General risks and complications: As with all surgical procedures, complications in the surgical treatment of femoral head necrosis can occur in the form of hematoma formation, wound healing disorders, wound infection, deep vein thrombosis, embolism, vascular and nerve injuries. General risks are generally more common than specific complications. Special complications: Special complications include, for example, lack of revascularization (= lack of ingrowth of blood vessels in the dead area) of the necrosis, lack of osteointegration of the bone graft (lack of ingrowth of the bone graft into the surrounding bone tissue), joint perforations.

b) Intertrochanteric osteotomy: In more advanced stages of femoral head necrosis, the aim of intertrochanteric osteotomy is to improve joint congruence by repositioning the deformed femoral head. This allows the damaged femoral head zone to be shifted out of the load. The improved congruence or the achieved relief of the necrosis site generally leads to an alleviation of the symptoms.

Here too, however, the chances of success decrease the more advanced the necrosis is. Depending on the stage of the disease and the general condition, childhood femoral head necrosis is often initially treated conservatively. Relief with walking aids, physiotherapy and pain medication are the basis of conservative therapy.

In advanced stages and if conservative treatment is unsuccessful, surgery may be necessary. A repositioning osteotomy is a frequently used method to straighten the femoral head.