BACKGROUND: Adult aseptic osteonecrosis (ON) represents a clinical picture with unexplained etiology. Since curative treatment of this disease often succeeds only in the early stage, pain therapy plays an important role in the treatment process. METHOD: We compared established and novel treatment options for ON as well as our own results after i.v. administration of the prostacyclin analogue iloprost with corresponding studies in the literature. RESULTS: In addition to treatment with nonsteroidal antirheumatic agents and opioids, surgical "core decompression," vasoactive medications, and hyperbaric oxygenation are effective. Treatment with iloprost for 5 days resulted in highly significant pain reduction. CONCLUSION: Symptomatic treatment is indicated in all stages of ON and curative treatment in stage I and early stage II. In cases of disease progression in the large joints, early endoprosthetic replacement is indicated to avoid secondary damage. In addition to employing vasoactive substances, a further curative treatment approach could be the use of mesenchymal stem cells.
BACKGROUND: Adult aseptic osteonecrosis (ON) represents a clinical picture with unexplained etiology. Since curative treatment of this disease often succeeds only in the early stage, pain therapy plays an important role in the treatment process. METHOD: We compared established and novel treatment options for ON as well as our own results after i.v. administration of the prostacyclin analogue iloprost with corresponding studies in the literature. RESULTS: In addition to treatment with nonsteroidal antirheumatic agents and opioids, surgical "core decompression," vasoactive medications, and hyperbaric oxygenation are effective. Treatment with iloprost for 5 days resulted in highly significant pain reduction. CONCLUSION: Symptomatic treatment is indicated in all stages of ON and curative treatment in stage I and early stage II. In cases of disease progression in the large joints, early endoprosthetic replacement is indicated to avoid secondary damage. In addition to employing vasoactive substances, a further curative treatment approach could be the use of mesenchymal stem cells.
Authors: Wolf Drescher; Karen P Weigert; Mathias H Bünger; Jørgen Ingerslev; Cody Bünger; Ebbe S Hansen Journal: J Orthop Res Date: 2004-05 Impact factor: 3.494
Authors: M den Heijer; T Koster; H J Blom; G M Bos; E Briet; P H Reitsma; J P Vandenbroucke; F R Rosendaal Journal: N Engl J Med Date: 1996-03-21 Impact factor: 91.245
Authors: Wolf Drescher; Thomas Schneider; Cordelia Becker; Lise Hobolth; Wolfgang Rüther; Cody Bünger; Ebbe S Hansen Journal: Clin Orthop Relat Res Date: 2002-09 Impact factor: 4.176
Authors: Marcus Jäger; Frank Peter Tillmann; Thomas S Thornhill; Marcus Mahmoudi; Dirk Blondin; Gerd Rüdiger Hetzel; Christoph Zilkens; Rüdiger Krauspe Journal: Arthritis Res Ther Date: 2008-10-03 Impact factor: 5.156