Zusammenfassung
Hintergrund
Die Hüftrevisionsendoprothetik gewinnt in Deutschland mit etwa 35.000 Operationen jährlich zunehmend an Bedeutung.
Fragestellung
Im Vordergrund stehen eine dauerhaft stabile Verankerung des Pfannenimplantates und des Schaftes im azetabulären und femoralen Knochen, sowie die Wiederherstellung des anatomischen Drehzentrums und die Rekonstruktion des Knochenlagers.
Methoden
Aktuelle Literatur und eigene Erfahrungsbeispiele werden dargestellt.
Ergebnisse und Schlussfolgerung
Neue Entwicklungen aus Forschung und Industrie erweitern die Versorgungsmöglichkeiten. Für ein schlüssiges Therapiekonzept bei der Implantatauswahl sollten Kriterien wie Defektsituation, Defektaufbau, Kombinierbarkeit mit verbliebenen Implantaten, Lockerungs- und Versagensursachen, Implanatallergie und patientenspezifische Parameter berücksichtigt werden.
Abstract
Background
Revision total hip arthroplasty is of rising importance, with 35,000 procedures a year in Germany.
Objectives
Primary stability of the revision implant, reconstruction of the anatomical hip center, reconstruction of bone stock, and permanent secondary integration are the main priorities.
Methods
Current literature and examples from our own experience are presented.
Results and conclusions
Novel developments from basic research and industrial partners extend the possibilities for treating affected patients. For an integrated therapy concept in implant selection criteria, such as situation and structure of the defect, combination with any remaining implants, causes of loosening and failure, implant allergy, and patient-specific parameters should be taken into consideration.
Literatur
Franz D, Roeder N (2012) Mengendynamik in den Krankenhäusern: auch eine gesellschaftliche Frage. Dtsch Arztebl 109(51–52):12
Statistisches Bundesamt W (2013) DRG-Statistik. Destatis, 21-Dez-2014
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133
Weber M, Woerner M, Springorum R, Sendtner E, Hapfelmeier A, Grifka J, Renkawitz T (2014) Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA. Clin Orthop 472(10):3150–3158
Renkawitz T, Haimerl M, Dohmen L, Gneiting S, Wegner M, Ehret N, Buchele C, Schubert M, Lechler P, Woerner M, Sendtner E, Schuster T, Ulm K, Springorum R, Grifka J (2011) Minimally invasive computer-navigated total hip arthroplasty, following the concept of femur first and combined anteversion: design of a blinded randomized controlled trial. BMC Musculoskelet Disord 12:192
Lehner B, Witte D, Suda AJ, Weiss S (2009) Revision strategy for periprosthetic infection. Orthop 38(8):681–688
Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R (1976) Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am 58(5):612–618
Willert HG, Semlitsch M (1977) Reactions of the articular capsule to wear products of artificial joint prostheses. J Biomed Mater Res 11(2):157–164
Krenn V, Morawietz L, Perino G, Kienapfel H, Ascherl R, Hassenpflug GJ, Thomsen M, Thomas P, Huber M, Kendoff D, Baumhoer D, Krukemeyer MG, Natu S, Boettner F, Zustin J, Kölbel B, Rüther W, Kretzer JP, Tiemann A, Trampuz A, Frommelt L, Tichilow R, Söder S, Müller S, Parvizi J, Illgner U, Gehrke T (2014) Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 210(12):779–786
Engh CA, Bobyn JD (1988) The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop 231:7–28
Ryd L, Linder L (1989) On the correlation between micromotion and histology of the bone-cement interface. Report of three cases of knee arthroplasty followed by roentgen stereophotogrammetric analysis. J Arthroplasty 4(4):303–309
Schaumburger J, Winkler S, Handel M, Grifka J, Baier C (2012) Prosthesis loosening. Z Für Rheumatol 71(9):785–797
Brade H, Brade L, Schade U, Zähringer U, Holst O, Kuhn HM, Rozalski A, Röhrscheidt E, Rietschel ET (1988) Structure, endotoxicity, immunogenicity and antigenicity of bacterial lipopolysaccharides (endotoxins, O-antigens). Prog Clin Biol Res 272:17–45
Gelb H, Schumacher HR, Cuckler J, Ducheyne P, Baker DG (1994) In vivo inflammatory response to polymethylmethacrylate particulate debris: effect of size, morphology, and surface area. J Orthop Res Off Publ Orthop Res Soc 12(1):83–92
Höhr D, Steinfartz Y, Schins RPF, Knaapen, G. Martra, B. Fubini, Borm PJA (2002) The surface area rather than the surface coating determines the acute inflammatory response after instillation of fine and ultrafine TiO2 in the rat. Int J Hyg Environ Health 205(3):239–244
Shanbhag AS, Jacobs JJ, Black J, Galante JO, Glant TT (1994) Macrophage/particle interactions: effect of size, composition and surface area. J Biomed Mater Res 28(1):81–90
Baumann B, Rolf O, Jakob F, Goebel S, Sterner T, Eulert J, Rader CP (2006) Synergistic effects of mixed TiAlV and polyethylene wear particles on TNFalpha response in THP-1 macrophages. Biomed Tech (Berl) 51(5–6):360–366
Bettin D, Katthagen BD (1997) [The German Society of orthopedics and traumatology classification of bone defects in total hip endoprostheses revision operations]. Z Für Orthop Ihre Grenzgeb 135(4):281–284
D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop 243:126–137
D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK, Steinberg ME, Wedge JH (1993) Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop 296:133–139
Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9(1):33–44
Della Valle CJ, Paprosky WG (2004) The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop 420:55–62
von Eisenhart-Rothe R, Gollwitzer H, Toepfer A, Pilge H, Holzapfel BM, Rechl H, Gradinger R (2010) Mega cups and partial pelvic replacement. Orthop 39(10):931–941
Gruner A, Heller K-D (2009) Revision hip arthroplastiy of the hip joint. Revision of the femur: which implant is indicated when? Orthop 38(8):667–680
Gravius S, Randau T, Wirtz DC (2011) What can be done when hip prostheses fail?: new trends in revision endoprosthetics. Orthop 40(12):1084–1094
Holzapfel BM, Greimel F, Prodinger PM, Pilge H, Nöth U, Gollwitzer H, Rudert M (2012) Total hip replacement in developmental dysplasia using an oval-shaped cementless press-fit cup. Int Orthop 36(7):1355–1361
Starker M, Kandziora F, Jäger A, Kerschbaumer F (1998) Acetabular reconstruction using acetabular reinforcement rings. Orthop 27(6):366–374
Mittelmeier W, Peters P, Ascherl R, Gradinger R (1997) Rapid prototyping. Construction of a model in the preoperative planning of reconstructive pelvic interventions. Orthop 26(3):273–279
Issack PS, Nousiainen M, Beksac B, Helfet DL, Sculco TP, Buly RL (2009) Acetabular component revision in total hip arthroplasty. Part II: management of major bone loss and pelvic discontinuity. Am J Orthop Belle Mead NJ 38(11):550–556
Gollwitzer H, von Eisenhart-Rothe R, Holzapfel BM, Gradinger R (2010) Revision arthroplasty of the hip: acetabular component. Chir Z Für Alle Geb Oper Med 81(4):284–292
Schuh A, Werber S, Holzwarth U, Zeiler G (2004) Cementless modular hip revision arthroplasty using the MRP titan revision stem: outcome of 79 hips after an average of 4 years’ follow-up. Arch Orthop Trauma Surg 124(5):306–309
Mumme T, Müller-Rath R, Andereya S, Wirtz DC (2007) Uncemented femoral revision arthroplasty using the modular revision prosthesis MRP-TITAN revision stem. Oper Orthop Traumatol 19(1):56–77
Steinbrink K, Engelbrecht E, Fenelon GC (1982) The total femoral prosthesis. A preliminary report. J Bone Joint Surg Br 64(3):305–312
Charissoux J-L, Asloum Y, Marcheix P-S (2014) Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res OTSR 100(Suppl 1):25–34
Guyen O, Pibarot V, Vaz G, Chevillotte C, Béjui-Hugues J (2009) Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop 467(2):465–472
Plummer DR, Haughom BD, Della Valle CJ (2014) Dual mobility in total hip arthroplasty. Orthop Clin North Am 45(1):1–8
Wirtz DC, Niethard FU (1997) [Etiology, diagnosis and therapy of aseptic hip prosthesis loosening – a status assessment]. Z Für Orthop Ihre Grenzgeb 135(4):270–280
Schmolders J, Friedrich MJ, Michel RD, Randau TM, Wimmer MD, Strauss AC, Kohlhof H, Wirtz DC, Gravius S (2015) Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation. Int Orthop 39(4):623–630
Garbuz DS, Penner MJ (1998) Role and results of segmental allografts for acetabular segmental bone deficiency. Orthop Clin North Am 29(2):263–275
Hoshino M, Namikawa T, Kato M, Terai H, Taguchi S, Takaoka K (2007) Repair of bone defects in revision hip arthroplasty by implantation of a new bone-inducing material comprised of recombinant human BMP-2, Beta-TCP powder, and a biodegradable polymer: an experimental study in dogs. J Orthop Res Off Publ Orthop Res Soc 25(8):1042–1051
Swarts E, Bucher TA, Phillips M, Yap FHX (2014) Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components. J Arthroplasty. doi:10.1016/j.arth.2014.10.028 (Epub ahead of print)
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B.S. Craiovan, J. Grifka, A. Keshmiri, B. Moser, M. Wörner und T. Renkawitz geben an, dass kein Interessenkonflikt besteht.
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Craiovan, B., Grifka, J., Keshmiri, A. et al. Defektadaptierte Rekonstruktionsstrategien in der Hüftrevisionsendoprothetik. Orthopäde 44, 366–374 (2015). https://doi.org/10.1007/s00132-015-3103-2
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DOI: https://doi.org/10.1007/s00132-015-3103-2