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Defektadaptierte Versorgung azetabulärer Knochendefekte mit dem Revisio-System

Treatment of acetabular bone defects in revision hip arthroplasty using the Revisio-System

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Zusammenfassung

Hintergrund

Für die defektorientierte Versorgung primärer und sekundärer Azetabulumdefekte steht eine Vielzahl an Operationsverfahren und Implantatsystemen zur Verfügung. Durch die verschiedenen Ausführungen des Revisio-Pfannensystems kann bei defektorientierter Indikationsstellung eine suffiziente Primärstabilität unter Rekonstruktion des Drehzentrums erreicht werden.

Material und Methoden

In einer konsekutiven Studie wurden 92 Hüftpfannenwechsel mit dem Kranialsockel-System, dem nahezu baugleichen Vorgängermodell des Revisio-Systems, nachuntersucht. Das durchschnittliche Follow-up lag bei 58,2 Monaten. Die Einteilung der knöchernen Defekte erfolgte nach der D’Antonio-Klassifikation. Es wurden 39 Hüften als Defekttyp Grad II, 38 als Defektgrad III und 15 als Defekttyp IV beschrieben. Das Implantatüberleben mit dem Endpunkt erneuter Pfannenwechsel lag bei 94,6 %, das Gesamtüberleben mit dem Endpunkt Revision aus jeglichem Grund bei 89,1 %. Klinisch stieg der Harris-Hip-Score (HHS) von präoperativ durchschnittlich 41,1 ± 17,1 Punkte auf 62,3 ± 21,8 Punkte postoperativ. Die Visuelle Analogskala (VAS) ergab eine Reduktion des Schmerzzustands von durchschnittlich 6,9 präoperativ auf 3,8 postoperativ.

Ergebnis

Das Revisio-Pfannensystem stellt ein vielversprechendes System zur defektorientierten zementfreien Versorgung von Azetabulumdefekten im Rahmen der Wechselendoprothetik dar. Die erzielten Ergebnisse zeigen ein gutes klinisches Outcome im mittelfristigen Verlauf.

Abstract

Background

Many different systems for the management of primary and secondary acetabular defects are available, each with its inherent advantages and disadvantages. The Revisio-System is a press-fit oval mono-block implant that makes a defect-oriented reconstruction and restoration of the center of rotation possible.

Material and methods

In this study, we retrospectively reviewed the outcome of 92 consecutive patients treated with this oval press-fit cup due to periacetabular bone loss. The average follow-up was 58.2 months. Defects were classified according to D’Antonio. There were 39 type II, 38 Type III, and 15 type IV defects. After an average of 4.9 years, the implant survival rate was 94.6% with cup revision as the end point and 89.1% with revision for any reason as the end point. The Harris Hip Score increased from 41.1 preoperatively to 62.3 postoperatively. The mean level of pain measured with the Visual Analogue Scale (VSA) was reduced from 6.9 preoperatively to 3.8 postoperatively.

Results

The Revisio-System represents a promising toolbox for defect-orientated reconstruction of acetabular bone loss in revision hip arthroplasty. Our results demonstrate that the implantation of the Revisio-System can result in a good mid-term clinical outcome.

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Authors and Affiliations

  1. Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland

    M. Hoberg, B. M. Holzapfel, A. F. Steinert, M. Walcher & M. Rudert

  2. Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4049, Brisbane, Australien

    B. M. Holzapfel

  3. Endogap Klinik für Gelenkersatz, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland

    F. Kratzer

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  1. M. Hoberg
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  2. B. M. Holzapfel
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  3. A. F. Steinert
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  4. F. Kratzer
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  5. M. Walcher
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  6. M. Rudert
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Correspondence to M. Hoberg.

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Interessenkonflikt

M. Hoberg, B. M. Holzapfel, A. F. Steinert, F. Kratzer, M. Walcher und M. Rudert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hoberg, M., Holzapfel, B.M., Steinert, A. et al. Defektadaptierte Versorgung azetabulärer Knochendefekte mit dem Revisio-System. Orthopäde 46, 126–132 (2017). https://doi.org/10.1007/s00132-016-3375-1

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