Zusammenfassung
Hintergrund
Beim Pincer-Impingement kommt es durch repetitive Kontusionen zwischen Pfannenrand und Schenkelhals primär zu einer Schädigung des Labrums und sekundär zu progredienten Knorpelschäden. Ohne frühzeitige Diagnostik und Behandlung ist mit der Entstehung einer vorzeitigen Arthrose zu rechnen. Ursprünglich erfolgte die Therapie im Rahmen eines offenen Eingriffs, meist in Kombination mit einer chirurgischen Hüftluxation.
Fragestellung
Wie gestaltet sich eine adäquate Diagnostik und welchen Stellenwert hat die Hüftarthroskopie in der Behandlung des femoroacetabulären Pincer-Impingements heute.
Material und Methode
Die Übersichtsarbeit basiert auf einer selektiven Literaturrecherche und der persönlichen Erfahrung.
Ergebnisse
Eine gezielte klinische Untersuchung und radiologische Abklärung, insbesondere mittels Arthro-MRT, ermöglicht eine frühzeitige, sichere Diagnosestellung. Die Literatur zeigt, dass eine arthroskopische Behandlung möglich ist.
Schlussfolgerungen
Bei ausreichender Erfahrung des Operateurs lassen sich heute die meisten Fälle arthroskopisch behandeln. Bei dieser minimal-invasiven Technik sind die Risiken gering. Neben der Reduktion des Pfannenrandes sind eine Refixation des Labrums und eine Sanierung von Knorpeldefekten technisch möglich geworden. Gleichzeitig können Pathologien am proximalen Femur angegangen werden. Die Erfolgsraten sind bei frühzeitiger Operation hoch, sinken jedoch mit zunehmenden Knorpelschäden. Entsprechend ist bei Hüftbeschwerden des jungen Patienten eine frühzeitige Diagnostik dringend indiziert.
Abstract
Background
In pincer impingement of the hip repetitive contusions between the acetabular rim and the femoral neck will initially cause lesions to occur in the labrum and eventually in the acetabular cartilage. Without appropriate treatment in an early stage, development of early onset osteoarthritis should be expected. For this particular topic the treatment of choice is surgery which was originally carried out by conventional open surgery, often in combination with dislocation of the hip as the standard procedure.
Objectives
This article presents the strategy for early diagnosis and the current role of hip arthroscopy in the treatment of femoroacetabular pincer impingement.
Methods
This study is based on a selective literature research and the author’s experience.
Results
Clinical examination and selective x-ray protocols, including magnetic resonance imaging arthrography (arthro-MRI) will give a clear diagnosis, even in early stages of the disease. Analysis of the literature shows that therapy can be carried out arthroscopically.
Conclusions
Depending on the level of surgical experience most cases can be treated arthroscopically which is a low risk and minimally invasive procedure. The arthroscopic technique not only allows trimming of the acetabular rim but also labral reconstruction and cartilage repair. In addition other pathologies of the proximal femur may be addressed at the same time. The overall success rates are high if therapy is carried out at an early stage of the disease; however, clinical outcome is less favorable with advanced stages of chondromalacia at the time of intervention. Under this aspect, an early and careful diagnostic work-up for hip pain is of particular importance especially in young and active patients.
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Interessenkonflikt. R.F. Herzog gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag enthält keine Studien an Menschen oder Tieren.
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Herzog, R. Femoroacetabuläres Pincer-Impingement. Arthroskopie 27, 109–117 (2014). https://doi.org/10.1007/s00142-013-0781-9
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DOI: https://doi.org/10.1007/s00142-013-0781-9