Successful Conservative Treatment Research Articles

Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

BackgroundSpontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients.Case presentationA 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH2O and at − 20 cmH2O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day.ConclusionConservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.

Surgical Intervention in Adhesive Intestinal Obstruction

Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.

CLINICAL CASE OF CONGENITAL SPONTANEOUS BILATERAL CHYLOTHORAX

Chylothorax is a pathological condition associated with the accumulation of lymphatic fluid in the pleural cavity. This pathology occurs quite rarely, but it is a complex and often life threatening disease that results in deep respiratory, metabolic and immunological disorders. Occurs in any age group, including the neonatal period. Currently, there are few reports of congenital chylothorax, no practical recommendations for the clinical management of this category of patients, mortality is from 20 % to 60 %. At present, there is no single point of view regarding the pathogenesis of the occurrence of chylothorax. In the modern literature, the following etiopathogenetic factors are indicated: iatrogenic causes (cardiothoracic surgical interventions, puncture of the central veins from the system of vena cava superior, trauma during labor), increased pressure in the system of the upper vena cava (thrombosis, congenital malformations of the heart), diaphragmatic hernia, congenital defects of lymphatic system (hypoplasia of vessels or vascular walls), lymphangiomatosis, genetic defects (Down syndrome, Noonan, monosomy X, etc.), congenital cytomegalovirus infection, inflammatory process. Infants in whom chylothorax has been diagnosed with up to 35 weeks of gestation and initiated prenatal treatment have improved postnatal results. In the postnatal period, the initial steps of the treatment include drainage of the pleural cavity, adequate ventilation, parenteral nutrition, specific enteral nutrition (a formula with high protein content, reduced lipid content, and, instead, should contain mid chain triglycerides - MCT), correction of albumin content, electrolytes (typical hyperkaliemia, hyponatremia) and drug therapy (octreotide). The clinical case of a premature baby with congenital bilateral chylothorax is an example of successful conservative treatment.

CT diagnosis of closed loop bowel obstruction mechanism is not sufficient to indicate emergent surgery.

To identify computed tomography (CT) findings associated with successful conservative treatment of closed loop small bowel obstruction (CL-SBO) due to adhesions or internal herniation. The local institutional review board approved this study while waiving informed consent. Clinical and CT data were collected retrospectively for 96 consecutive patients with a CT diagnosis of CL-SBO due to adhesions or internal herniation established by experienced radiologists who had no role in patient management. Mechanical obstruction with at least two transition zones on the bowel at a single site defined CL-SBO. Two radiologists blinded to patient data independently performed a retrospective review of the CT scans. The patient groups with successful versus failed initial conservative therapy were compared. Univariate and multivariate analyses were performed to look for CT findings associated with successful conservative therapy. Interobserver agreement was assessed for each CT finding. Of the 96 patients, 34 (35%) underwent immediate surgery and 62 (65%) received first-line conservative treatment, which succeeded in 19 (31%) and failed in 43 (69%). The distance between the transition zones was the only independent predictor of successful conservative therapy (odds ratio, 4.6 when ≥ 8mm; 95% confidence interval [95% CI], 1.2-18.3). A distance ≥ 8mm had 84% (95% CI, 60-97) sensitivity and 46% (95% CI, 31-62) specificity for successful conservative treatment. The correlation coefficient for the distance between transition zones between readers 1 and 2 was fair (r = 0.46). CL-SBO can be resolved without surgery. When there is no CT sign of ischemia, the distance between the transition zones should be assessed. • Twenty percent (19/96) of all cases of closed loop small bowel obstruction (CL-SBO) representing 31% of the patients given first-line conservative therapy, were resolved without surgery. • The distance between the transition zones may help to choose between conservative and surgical management in patients with a CL-SBO but no CT evidence of ischemia. • A distance < 8mm between the transition zones suggests a need for emergent surgery.

Borderline pneumothorax

Extraordinary demanding case requires creative solution within expenditure of intellectual energy supported by mature experience, and discerning intuition. This all with single rule: patients benefit. Previous and subsequent sharing and exchange yield full-blown versatility. Pneumothorax in breastfeeding mother, brachial plexus injury caused by lysis of apical adhesions, support of pulmonary plication by autologous fascia lata in advanced pulmonary emphysema, dorsal chest tube insertion through first intercostal space, stubborn pneumothorax in a musician of brass band, successful conservative treatment by chest tube as an alternative of thoracoplasty, talc slurry solution in elderly man with life threatening pneumothorax from advanced lung cancer decay cavity, and in young woman afflicted by lymphangioleiomyomatosis (LAM) are briefly reported.

Successful conservative treatment of intestinal perforation in VLBW and ELBW neonates: a single centre case series and review of the literature

BackgroundThe current standard treatment of neonates with intestinal perforation is surgery. However, the mortality rate after surgical treatment for intestinal perforation is very high for very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. In this review, conservative treatment of pneumoperitoneum among VLBW and ELBW neonates is investigated.MethodsBetween January 2015 and December 2017, data from all of the VLBW and ELBW neonates with pneumoperitoneum who survived without surgical treatment were collected from Shenzhen Maternity and Child Healthcare Hospital in Guangdong, China. Twenty-two neonates with birth weight less than 1500 g were diagnosed with pneumoperitoneum. Following careful evaluation and discussion, eleven were treated conservatively and this was successful in eight. Details of the eight neonates including birth weight, gestational age, gender, risk factors, time of the perforation, treatment and prognosis were retrospectively recorded. A literature review was performed of previously reported cases that had used conservative treatment.ResultsThe median gestational age and birth weight of the eight neonates were 27+ 1 weeks (range 24w+ 3 to 31w+ 6) and 855 g (range 650 g to 1440 g), respectively. Pneumoperitoneum was confirmed by X-ray in all at a median of 8 days of life. They received full parenteral support for a median of 22 days. All eight neonates received a combination of piperacillin-tazobactam and meropenem as first-choice antibiotics, two of them also received fluconazole as anti-fungal medication. Median duration of hospitalisation was 80 days.ConclusionsConservative treatment with careful surveillance may be a practical choice for the VLBW and ELBW neonates with intestinal perforation. Further studies are needed for confirmation.

Results of efferent therapy in monochorionic diamniotic twins with dissociation of fetal development (three clinical observations)

The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.

Therapeutic effect of gastrografin and predictors of operative intervention in patients with adhesive small bowel obstruction: A randomized controlled study.

The study aimed to investigate the therapeutic effect of gastrografin for the conservative treatment of patients with adhesive small bowel obstruction (ASBO) and to identify the predictors of failure of conservative treatment in these patients. A randomized controlled trial was conducted on 52 patients with the diagnosis of ASBO in 2016. 100 mL of Gastrografin and 100 mL of 0.9% saline solution were gavaged through the nasogastric tube in the case (n= 26) and control (n= 26) groups, respectively. Patients in the case group were subjected to plain abdominal X-Rays at 12, 24 and 48 hours after administration of gastrografin. Fifty-two patients with a mean age of 57.6 ± 11.4 years (range 37-81), including 34 (65.4%) males were enrolled into the study. The number of patients who were successfully conservatively treated in the case group was 21 (80.8%), which was significantly higher than 13 (50%) in the control group (p= 0.04). Among these patients, mean hospital stay in the case group was 37.2 ± 5.5 hours (range 28-46), which was significantly shorter than 45.8 ± 9.2 hours (range 36-61) in the control group (p= 0.004). In multivariate analysis, more than one previous laparotomy was the only predictor of failure of conservative treatment (p <0.001). Gastrografin may be associated with improvement of patients with ASBO. Lower number of previous laparotomies may be a predictor of successful conservative treatment of these patients.

61 - Grade V kidney trauma (shattered kidney) eventually needing nephrectomy after initially successful conservative treatment – a case presentation

61 - Grade V kidney trauma (shattered kidney) eventually needing nephrectomy after initially successful conservative treatment – a case presentation

Influence of hip joint dysfunction on motor disorders in Japanese patients with osteoarthritis of the hip: Assessment of the JHEQ and GLFS-25 scores and hip muscle strength

BackgroundMotor disorders are caused by orthopedic problems that are mainly related to aging. These disorders can lead to a decline of physical activity and impairment of ADL. When evaluating a patient’s motor function after treatment, it is necessary to determine whether or not the level of function is age-appropriate. To investigate the influence of hip joint dysfunction on motor disorders, we determined the JHEQ and GLFS-25 scores and performed muscle strength testing in female patients with hip osteoarthritis. MethodsThe subjects were 108 women who had received THA, 56 women scheduled for THA, and 64 women on conservative treatment. The JHEQ score (evaluation scale for hip joint function) and GLFS-25 score (evaluation scale for ADL) were determined and muscle strength testing was conducted at a routine outpatient visit. ResultsA strong correlation was found between the total JHEQ score and the GLFS-25 score (r = - 0.837). Patients after THA and patients with successful conservative treatment aged 60–79 years showed similar motor function to healthy persons of the same age. There was a significant difference of straight leg raising and abduction strength (both p < 0.01) between patients in GLFS-25 levels 1–3 and patients in GLFS-25 levels 4–7. ConclusionWhile hip joint dysfunction has a strong influence on overall motor function, the patients after THA and patients with successful conservative treatment showed similar motor function to healthy persons of the same age. And patients with hip osteoarthritis must preserve or increase SLR strength to maintain adequate motor function.

Milia over tattoo: successful conservative treatment

Milia over tattoo: successful conservative treatment

Wunderlich’s syndrome associated with anticoa­ gulant treatment, heart failure, and post-radiation vasculopathy (RCD code: I-O)

Background: Wunderlich’s syndrome (WS) is an extremely rare condition, characterised by spontaneous haemorrhage into the subcapsular, perirenal, and retroperitoneal spaces. The most common cause is renal angiomyolipoma. Classic symptoms, such as acute flank pain, flank mass, and hypovolemic shock, known as Lenk’s triad, have limited sensitivity and specificity for detecting WS. High mortality may be related to the difficulties in diagnosis, poor disease recognition, and non‐specific symptoms and signs. Computed tomography (CT) is the method of choice for the diagnosis of WS. Depending on the severity of symptoms, a conservative or invasive approach is reasonable. Methods and results: We report the case of a 58‐year‐old male with multivalvular heart defect, atrial fibrillation, and exacerbation of chronic heart failure complicated with nontraumatic bleeding into the retroperitoneal space. CT revealed a massive (14x11x26 cm) retroperitoneal and perirenal haematoma. The patient was successfully treated with transfusion of red blood cells, fresh frozen plasma, and intravenous fluids. Simultaneously, heart failure treatment was initiated. In view of the chronic and idiopathic character of the haematoma and successful conservative treatment, there was no indication for surgery. Discussion: Several factors might have contributed to the bleeding. First, the patient was receiving anticoagulant treatment to reduce the risk of arterial thromboembolism in atrial fibrillation. Another possible cause is post‐radiation vasculopathy, an adverse effect of previous radiation therapy for malignant granuloma. The third factor which could have contributed to bleeding was the exacerbation of chronic heart failure and pulmonary hypertension. JRCD 2019; 4 (2): 51-55.

Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release?

Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.

A Case of Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis Treated by a Successful Conservative Treatment.

A Case of Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis Treated by a Successful Conservative Treatment.

Incidental Urinary Bladder Leiomyoma: A Successful Long Term Conservative Treatment Based on Pre-operatory Magnetic Resonance Imaging Findingsr

Incidental Urinary Bladder Leiomyoma: A Successful Long Term Conservative Treatment Based on Pre-operatory Magnetic Resonance Imaging Findingsr

Traitement conservateur des lésions du croisé antérieur de l’enfant : à propos d’une série de 53 patients

IntroductionThe last symposium held by the French Arthroscopy Society was on anterior cruciate ligament (ACL) reconstruction on children. The first aim of this study was to analyse the tolerance of conservative management of ACL rupture in children. We also tried to find predictive factors of ACL reconstruction. Material and methodsWe conducted an observational, retrospective study in an academic department of paediatric orthopaedic surgery. All patients under the age of eighteen, who were treated conservatively for an acute intra-ligamentous ACL rupture confirmed by magnetic resonance imaging (MRI) between 2007 and 2017, were included. Two groups were analysed: operated patients and conservative treatment. We also analysed population according Tanner stage. ResultsFifty-three patients were included in this study. The median length of follow-up was 31.5 months [interquartile range (IQR): 22.3–49.3]. The median age at the last follow-up was 14.4 years [IQR: 12.6–15.5]. All patients were allowed to practice activities without restrictions, including pivoting sports. Tegner activity level scale remains identical before injury and at last follow-up (p: n.s.). Nineteen patients (36%) described knee instability at last follow-up. On the last MRI, 9 (17%) patients had meniscal tears but only one patient (2%) needed a menisectomy. Twenty-one patients (40%) underwent ACL reconstruction. The 4-years successful conservative treatment rate was 92% (95% CI: 85–98%). Clinical instability at first examination was the only significant predictive factors of bad tolerance of conservative management (p=0.047). DiscussionConservative management of ACL rupture in paediatric population is a valuable treatment which permits return to a normal life with sports activities without major increasing of meniscal tears. The rehabilitation protocol must restore full knee stability to permit a successful conservative treatment. We must study the impact of pubertal status on larger group. Level of evidenceIV, retrospective study.

Partial tubal devascularisation: a novel procedure for tubal conservation in ectopic pregnancy

Ectopic pregnancy is a serious condition that complicates 1–2% of pregnancies. Using surgical management is efficient, but may have an impact on future fertility. Although conservative tubal surgery has not been shown to have a significant advantage over a salpingectomy in terms of the future fertility potential, the conservative surgical techniques remain widely-utilised, particularly in the context of a contralateral diseased or absent tube. We hereby report a case series of a novel procedure to conserve the fallopian tube with the minimal risk of an incisional site bleeding through a partial segmental devascularisation. This technique seems to be an efficient method to minimise the intraoperative bleeding, limit the need for a blood transfusion, and yields a higher success rate of the procedure without jeopardising the blood supply and vitality of the tubes.Impact StatementWhat is already known on this subject? Conservative surgery has a significant value in women with a contralateral absent or diseased tube. However, a conservative management could be challenging due to the significant bleeding which can be encountered during the surgery.What the results of this study add? The partial devascularisation technique could achieve an adequate haemostasis by blocking the ascending blood supply only to the affected segment of the fallopian tube.What the implications are of these findings for clinical practice and/or further research? A partial devascularisation is a successful conservative surgical treatment option in most patients when the procedure is indicated.

The factors of deterioration in long-term clinical course of lumbar spinal canal stenosis after successful conservative treatment

BackgroundThe treatment of lumbar spinal canal stenosis (LSS) depends on symptom severity. In the absence of severe symptoms such as severe motor disturbances or bowel and/or urinary dysfunction, conservative treatment is generally the first choice for the treatment of LSS. However, we experienced cases of worsening symptoms even after successful conservative treatment. The purpose of this study is to investigate the long-term clinical course of LSS following successful conservative treatment and analyze the prognostic factors associated with symptom deterioration.MethodsThe study included 60 LSS patients (34 females and 26 males) whose symptoms were relieved by conservative treatment between April 2007 and March 2010 and who were followed up for 5 years or longer. The mean age at admission was 64.8 ± 8.5 years (range, 40–85 years old), and the mean follow-up period was 7.3 years (range, 5.8–9.5 years). We defined “deterioration” of symptoms as the shortening of intermittent claudication more than 50 m compared with those at discharge or the occurrence or progression of lower limb paralysis, and “poor outcome” as the deterioration within 5 years after discharge. The long-term outcome of conservative treatment for LSS was analyzed by Kaplan-Meier analysis. Furthermore, logistic regression analysis was performed to reveal the risk factors of poor outcome for clinical classification, severe intermittent claudication (≤ 100 m), lower limb muscle weakness, vertebral body slip (≥ 3 mm), scoliosis (Cobb angle ≥ 10°), block on myelography, and redundant nerve roots of the cauda equina.ResultsThirty-four (56.7%) patients preserved their condition at discharge during the follow-up, whereas 26 patients (43.3%) showed deterioration. Sixteen patients had a decreased intermittent claudication distance, and 10 patients had newly developed or progressive paralysis. The probability of preservation was maintained at 68.3% at 5 years after discharge. Logistic regression analysis demonstrated that only severe intermittent claudication (≤ 100 m) was a significant risk factor of a poor outcome (p = 0.005, odds ratio = 6.665).ConclusionsThe patients with severe intermittent claudication should be carefully followed up because those are the significant deterioration candidates despite the success in conservative treatment.

Conservative management of anterior cruciate ligament injury in paediatric population: About 53 patients

IntroductionThe last symposium held by the French Arthroscopy Society was on anterior cruciate ligament (ACL) reconstruction on children. The first aim of this study was to analyse the tolerance of conservative management of ACL rupture in children. We also tried to find predictive factors of ACL reconstruction. Material and methodsWe conducted an observational, retrospective study in an academic department of paediatric orthopaedic surgery. All patients under the age of eighteen, who were treated conservatively for an acute intra-ligamentous ACL rupture confirmed by magnetic resonance imaging (MRI) between 2007 and 2017, were included. Two groups were analysed: operated patients and conservative treatment. We also analysed population according Tanner stage. ResultsFifty-three patients were included in this study. The median length of follow-up was 31.5 months [interquartile range (IQR): 22.3–49.3]. The median age at the last follow-up was 14.4 years [IQR: 12.6–15.5]. All patients were allowed to practice activities without restrictions, including pivoting sports. Tegner activity level scale remains identical before injury and at last follow-up (p: n.s.). Nineteen patients (36%) described knee instability at last follow-up. On the last MRI, 9 (17%) patients had meniscal tears but only one patient (2%) needed a menisectomy. Twenty-one patients (40%) underwent ACL reconstruction. The 4-years successful conservative treatment rate was 92% (95% CI: 85–98%). Clinical instability at first examination was the only significant predictive factors of bad tolerance of conservative management (p=0.047). DiscussionConservative management of ACL rupture in paediatric population is a valuable treatment which permits return to a normal life with sports activities without major increasing of meniscal tears. The rehabilitation protocol must restore full knee stability to permit a successful conservative treatment. We must study the impact of pubertal status on larger group. Level of evidenceIV, retrospective study.

Conservative treatment of atraumatic femoral head necrosis

Femoral head necrosis is a progressive disease that can progress within a relatively short time. Therefore, an early and clear diagnosis including stage classification and treatment is necessary to prevent or delay the onset of the femoral head and joint destruction. In addition to the identification of possible risk factors and treatment, the question of the available treatment options arises. The present article deals with conservative treatment options and presents the published results in the sense of the currently available evidence and against the background of the S3 guideline on atraumatic femoral head necrosis. The results of physical therapy, drug therapy (iloprost and bisphosphonates ), electrotherapy, shockwave therapy, etc. are presented. In the early stages of femoral head necrosis with low expansion, alendronate gives positive results. Iloprost is also a successful conservative treatment option in the early stages of atraumatic femoral head necrosis (ARCO I and II). In stages ARCO III and IV, Ilomedin is no longer indicated. Anticoagulants, such as enoxaparin, have demonstrated an arthroprotective effect.