title: [Bone marrow edema and atraumatic necrosis of the femoral head : Therapy].
abstract: BACKGROUND
  An increase in interstitial bony fluid occurs in bone-marrow edema (BME). The exact pathogenetic processes still remain unknown. BME is an unspecific finding that can occur on its own or accompany multiple diseases and pathologies.
  
  
  OBJECTIVE
  Literature review and presentation of new guidelines.
  
  
  METHODS
  This is a narrative literature review followed by current advice for the therapy of atraumatic osteonecrosis of the hip, based on the recently published S3-guidelines for this disease.
  
  
  CONCLUSIONS
  The differentiation of at least 3 different etiologies is proposed (mechanic, reactive and ischemic). Difficult, but important, is the distinction between the mostly painful, but benign entities (BME syndrome, bone bruise) and the progressive pathologies (osteonecrosis, arthritis, CRPS, tumour). Treatment options are dependent on etiology and clinic and can often be symptomatic. Core decompression is the surgical gold standard, leading to immediate pressure relief and therefore reduction in pain. Recently, it was shown that intravenous administration of Iloprost and bisphosphonates are also effective in achieving a reduction of BME and pain, with considerable improvement in the accompanying symptoms. The combination of core decompression and infusion seems to be another possible optimization ofthe therapy, in particular in the treatment of osteonecrosis.
authors.affiliation: Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland. drjbeckmann@gmx.de.
authors.forename: J
authors.initials: J
authors.lastname: Beckmann
authors.affiliation: Bereich Endoprothetik/Orthopädie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig AöR, Leipzig, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Roth
authors.affiliation: Orthopädische Gemeinschaftspraxis, Heinsberg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Niethard
authors.affiliation: Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Mauch
authors.affiliation: Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Best
authors.affiliation: Universitätsklinik für Orthopädie und Unfallchirurgie, Klinik für Orthopädie und spezielle orthopädische Chirurgie, Pius-Hospital Oldenburg, Oldenburg, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Maus
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D001855:Bone Marrow Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D019299:Decompression, Surgical / Q000379:methods* / Q000592:standards*; D004164:Diphosphonates / Q000008:administration & dosage* / Q000592:standards; D019317:Evidence-Based Medicine; D005264:Femoral Fractures / Q000175:diagnosis / Q000628:therapy; D005271:Femur Head Necrosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005858:Germany; D006801:Humans; D009985:Orthopedics / Q000592:standards*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonates; Hip prosthesis; OsteonecrosisIloprost; Surgical decompression