Therapy according to the stages | Stages of femoral head necrosis

Therapy according to the stages

Depending on the stage classification according to ARCO, the treating orthopaedic surgeon decides which therapy for femoral head necrosis is appropriate: Early stages: In stages 0 and 1, relief of the joint with crutches in combination with physiotherapy and anti-inflammatory painkillers such as ibuprofen or diclofenac can be successful. Drugs with the active ingredient iloprost have a vasodilating and blood circulation-promoting effect and can thus lead to an improvement in the clinical picture. In addition, physical therapy methods such as shock wave therapy or magnetic field therapy can be successful in the early stages.

Advanced stages: In stages 1 and 2, core decompression is the standard therapy. In this procedure, the femoral head is drilled in an operation, thereby reducing the pressure in the bone marrow. This can prevent or at least delay the progression of femoral head necrosis.

It is also possible that repair mechanisms and the formation of new vessels are stimulated in this way. In modern therapeutic approaches, the drilling process involves the injection of endogenous stem cells into the bone, where they are intended to support the new formation of bone.

  • Early stages: In stages 0 and 1, relief of the joint with crutches in combination with physiotherapy and anti-inflammatory painkillers such as ibuprofen or diclofenac can be successful.

    Drugs with the active ingredient iloprost have a vasodilating and blood circulation-promoting effect and can thus lead to an improvement in the clinical picture. In addition, physical therapy methods such as shock wave therapy or magnetic field therapy can be successful in the early stages.

  • Advanced stages: In stages 1 and 2, core decompression is the standard therapy. In this procedure, the femoral head is drilled in one operation, thus reducing the pressure in the bone marrow.

    This can prevent or at least delay the progression of femoral head necrosis. It is also possible that repair mechanisms and the formation of new vessels are stimulated in this way. In modern therapeutic approaches, the drilling process involves the injection of endogenous stem cells into the bone, where they are intended to support the new formation of bone.

  • Late stages: In stages 3 and 4 a so-called repositioning osteotomy is often performed.In this operation, an artificial fracture is created at the neck of the femur and the femoral head is “repositioned”, i.e. turned out of the stress zone.

    As a result, it “fits” better into the acetabulum and the damaged bone is relieved. However, this method only works if there is still sufficient healthy bone tissue. If, on the other hand, too large a part of the femoral head is already affected by necrosis, the only solution is to replace the joint with an artificial hip joint (total endoprosthesis, TEP).