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Der Orthopäde

, Volume 44, Issue 7, pp 510–522 | Cite as

Hüftendoprothetik bei Deformitäten des proximalen Femurs

  • A. Rakow
  • P. Simon
  • C. Perka
Leitthema
  • 702 Downloads

Zusammenfassung

Einleitung

Deformitäten des proximalen Femurs können zu schwerwiegenden funktionellen Defiziten und starken Schmerzen des ipsilateralen Hüftgelenkes führen, die schließlich die endoprothetische Versorgung dieses Gelenkes indizieren.

Vorgehen

Hüftendoprothetische Primäreingriffe bei einer komplex veränderten Anatomie des proximalen Femurs stellen eine technische Herausforderung für den Operateur dar. Die Deformität und die ihr zugrunde liegende Erkrankung, sei sie angeboren oder erworben, können die Präparation des Femurschaftes erschweren und die Wahl der Prothese, des operativen Zugangs sowie des postoperativen Physiotherapieregimes beeinflussen. Zudem kann ein mehrzeitiges operatives Vorgehen erforderlich werden, beispielsweise zur Entfernung von sich in situ befindenden Implantaten, zur Durchführung einer Femurosteotomie oder zum sicheren Ausschluss eines Infektes.

Diskussion

Jede endoprothetische Versorgung in Gegenwart eines deformierten proximalen Femurs erfordert ein individuelles Vorgehen unter Beachtung der Bedürfnisse des Patienten, der Ätiologie, der Lokalisation und der Geometrie der Femurdeformität, der Knochenqualität, des Zustandes der Weichteile, des Vorhandenseins von Implantaten im proximalen Femur, des infektiologischen Status und der Begleiterkrankungen des Patienten.

Schlüsselwörter

Deformität Femur Hüftendoprothetik Management Osteotomie 

Hip arthroplasty in the presence of proximal femoral deformity

Abstract

Introduction

Proximal femoral deformities may result in pain in the ipsilateral hip joint and profound functional disability, ultimately requiring arthroplasty. 

Procedure

Primary hip replacement procedures in the presence of markedly altered anatomy of the proximal femur present a technical challenge for the orthopedic surgeon. The deformity and its underlying condition, whether congenital or acquired, may complicate canal preparation and affect the choices of implant, exposure and postoperative physiotherapy protocol. Furthermore, a two- or multi-stage treatment may be required, e.g. for implant removal, for femoral osteotomy or to rule out infection.

Discussion

Treatment strategies must be individually tailored, respecting patient needs, the etiology, the anatomic site and the geometry of the deformity encountered, bone quality, soft tissue deficits, the presence of retained implants in the proximal femur, infection status and comorbidities.

Keywords

Deformities Femur Hip replacement / Hip arthroplasty Management Osteotomy 

Notes

Danksagung

Die Autoren danken Frau Christin Mannheim für die Erstellung der Abb. 1a und b.

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Perka weist auf folgende Beziehungen hin: Berater für Smith & Nephew GmbH, Aesculap Implant Systems, DePuy Synthes Joint Reconstruction, Pluristem Therapeutics, Ceram Tec und Zimmer. A. Rakow und P. Simon geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

Literatur

  1. 1.
    Akbar MAG, Krahmer K, Bruckner T, Aldinger PR (2009) Custom stems for femoral deformity in patients less than 40 years of age: 70 hips followed for an average of 14 years. Acta Orthop 80(4):420–425PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr (2013) Total hip arthroplasty after failed internal fixation of proximal femoral fractures. J Arthroplasty 28(1):168–171PubMedCrossRefGoogle Scholar
  3. 3.
    Aronson J (1986) Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect 35:119–128PubMedGoogle Scholar
  4. 4.
    Bergmann G, Graichen F, Rohlmann A, Linke H (1997) Hip joint forces during load carrying. Clin Orthop Relat Res 335:190–201PubMedGoogle Scholar
  5. 5.
    Berry DJ (1999) Total hip arthroplasty in patients with proximal femoral deformity. Clin Orthop Relat Res 369:262–272PubMedCrossRefGoogle Scholar
  6. 6.
    Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J (2006) Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients. Acta Orthop 77(4):638–643PubMedCrossRefGoogle Scholar
  7. 7.
    Boos N, Krushell R, Ganz R, Müller ME (1997) Total hip arthroplasty after previous proximal femoral osteotomy. J Bone Joint Surg Br 79-B(2):247–253CrossRefGoogle Scholar
  8. 8.
    Breusch S, Lukoschek M, Thomsen M, Mau H, Ewerbeck V, Aldinger P (2005) Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy. Arch Orth Traum Surg 125(5):304–309CrossRefGoogle Scholar
  9. 9.
    Buly RL, Huo M, Root L, Binzer T, Wilson PD Jr (1993) Total hip arthroplasty in cerebral palsy. Long-term follow-up results. Clin Orthop Relat Res 296:148–153PubMedGoogle Scholar
  10. 10.
    Chaus GW, Heare T (2012) End-stage posttraumatic osteoarthritis treated with THA in osteogenesis imperfecta. Orthopedics 35(6):e950–953PubMedCrossRefGoogle Scholar
  11. 11.
    Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61(1):15–23PubMedGoogle Scholar
  12. 12.
    Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Booth RE Jr, Parvizi J (2015) The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip. Clin Orthop Relat Res 473(1):198–203PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ferguson G, Cabanela M, Ilstrup D (1994) Total hip arthroplasty after failed intertrochanteric osteotomy. J Bone Joint Surg Br 76-B(2):252–257Google Scholar
  14. 14.
    Ganz RLM, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Haidukewych GJ, Berry DJ (2003) Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am 85(5):899–904PubMedGoogle Scholar
  16. 16.
    Harris W (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33PubMedGoogle Scholar
  17. 17.
    Haverkamp D, de Jong PT, Marti RK (2006) Intertrochanteric osteotomies do not impair long-term outcome of subsequent cemented total hip arthroplasties. Clin Orthop Relat Res 444:154–160PubMedCrossRefGoogle Scholar
  18. 18.
    Iwase T, Hasegawa Y, Iwasada S, Kitamura S, Iwata H (1999) Total Hip Arthroplasty After Failed Intertrochanteric Valgus Osteotomy for Advanced Osteoarthrosis. Clin Orthop Relat Res 364:175–181PubMedCrossRefGoogle Scholar
  19. 19.
    Kanner WA, Saleh KJ, Frierson HF (2008) Reassessment of the Usefulness of Frozen Section Analysis for Hip and Knee Joint Revisions. Am J Clin Pathol 130(3):363–368PubMedCrossRefGoogle Scholar
  20. 20.
    Kaplan F (1999) Surgical management of Paget’s disease. J Bone Miner Res 14(Suppl 2):34–38PubMedCrossRefGoogle Scholar
  21. 21.
    Kawasaki M, Hasegawa Y, Sakano S, Masui T, Ishiguro N (2005) Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Arthroplasty 20(5):574–579PubMedCrossRefGoogle Scholar
  22. 22.
    Krishnan H, Patel NK, Skinner JA, Muirhead-Allwood SK, Briggs TW, Carrington RW, Miles J (2013) Primary and revision total hip arthroplasty in osteogenesis imperfecta. Hip Int 23(3):303–309PubMedCrossRefGoogle Scholar
  23. 23.
    Mabry TM, Prpa B, Haidukewych GJ, Harmsen WS, Berry DJ (2004) Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg Am 86-A(10):2263–2267PubMedGoogle Scholar
  24. 24.
    Mattingly DA (2005) The S-rOM modular femoral stem in dysplasia of the hip. Orthopedics 28(9 Suppl):1069–1073Google Scholar
  25. 25.
    McKinley JC, Robinson CM (2002) Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am 84-A(11):2010–2015PubMedGoogle Scholar
  26. 26.
    Mehlhoff TLG, Tullos HS (1991) Total hip arthroplasty following failed internal fixation of hip fractures. Clin Orthop Relat Res 269:32–37PubMedGoogle Scholar
  27. 27.
    Miyamae Y, Inaba Y, Kobayashi N, Choe H, Yukizawa Y, Ike H, Saito T (2013) Different diagnostic properties of C-reactive protein, real-time PCR, and histopathology of frozen and permanent sections in diagnosis of periprosthetic joint infection. Acta Orthop 84(6):524–529PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A (2006) Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty 21(5):664–669PubMedCrossRefGoogle Scholar
  29. 29.
    Papagelopoulos PJ, Trousdale RT, Lewallen DG (1996) Total hip arthroplasty with femoral osteotomy for proximal femoral deformity. Clin Orthop Relat Res 332:151–162PubMedCrossRefGoogle Scholar
  30. 30.
    Parvizi J, Schall DM, Lewallen DG, Sim FH (2002) Outcome of uncemented hip arthroplasty components in patients with Paget’s disease. Clin Orthop Relat Res 403:127–134PubMedCrossRefGoogle Scholar
  31. 31.
    Parvizi J, Klein GR, Sim FH (2006) Surgical management of Paget’s disease of bone. J Bone Miner Res 21(S 2):P75–P82PubMedCrossRefGoogle Scholar
  32. 32.
    Perka C, Fischer U, Taylor WR, Matziolis G (2004) Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am 86-A(2):312–319PubMedGoogle Scholar
  33. 33.
    Perka C, Thomas R, Zippel H (2000) Subtrochanteric corrective osteotomy for the endoprosthetic treatment of high hip dislocation. Arch Orth Traum Surg 120(3–4):144–148CrossRefGoogle Scholar
  34. 34.
    Queally JM, Abdulkarim A, Mulhall KJ (2009) Total hip replacement in patients with neurological conditions. J Bone Joint Surg Br 91-B(10):1267–1273CrossRefGoogle Scholar
  35. 35.
    Ramaswamy R, Kosashvili Y, Cameron H (2009) Bilateral total hip replacement in osteogenesis imperfecta with hyperplastic callus. J Bone Joint Surg Br 91-B(6):812–814CrossRefGoogle Scholar
  36. 36.
    Rogmark C, Johnell O (2006) Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2289 patients. Acta Orthop 77(3):359–367PubMedCrossRefGoogle Scholar
  37. 37.
    Rogmark C, Carlsson Å, Johnell O, Sernbo I (2002) A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: functional outcome for 450 patients at two years. J Bone Joint Surg Br 84-B(2):183–188CrossRefGoogle Scholar
  38. 38.
    von Roth P, Abdel MP, Wauer F, Winkler T, Wassilew G, Diederichs G, Perka C (2014) Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint Jl 96-B(12):1618–1622CrossRefGoogle Scholar
  39. 39.
    Schroeder K, Hauck C, Wiedenhöfer B, Braatz F, Aldinger P (2010) Long-term results of hip arthroplasty in ambulatory patients with cerebral palsy. Int Orthop 34(3):335–339PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Schuh A, Schraml A, Hohenberger G (2009) Long-term results of the Wagner cone prosthesis. Int Orthop 33(1):53–58PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Shinar AA, Harris WH (1998) Cemented total hip arthroplasty following previous femoral osteotomy. J Arthroplasty 13(3):243–253PubMedCrossRefGoogle Scholar
  42. 42.
    Suzuki K, Kawachi S, Matsubara M, Morita S, Jinno T, Shinomiya K (2007) Cementless total hip replacement after previous intertrochanteric valgus osteotomy for advanced osteoarthritis. J Bone Joint Surg Br 89-B(9):1155–1157CrossRefGoogle Scholar
  43. 43.
    Tilzey JF, Iorio R (2013) Previous proximal femoral fracture and proximal femoral deformity. In: Berry DJ, Lieberman JR (Hrsg) Surgery of the Hip. Elsevier Saunders, Philadelphia. (Kapitel 77)Google Scholar
  44. 44.
    Tischler EH, Cavanaugh PK, Parvizi J (2014) Leukocyte esterase strip test: matched for musculoskeletal infection society criteria. J Bone Joint Surg Am 96(22):1917–1920PubMedCrossRefGoogle Scholar
  45. 45.
    Tohtz S, Müller M, Morawietz L, Winkler T, Perka C (2010) Validity of frozen sections for analysis of periprosthetic loosening membranes. Clin Orthop Relat Res 468(3):762–768PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Trampuz A, Widmer AF (2006) Infections associated with orthopedic implants. Curr Opin Infect Dis 19(4):349–356PubMedCrossRefGoogle Scholar
  47. 47.
    Trampuz A, Zimmerli W (2006) Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 37(Suppl 2):59–66CrossRefGoogle Scholar
  48. 48.
    Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM, West CP, Osmon DR, Berbari EF (2012) Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection. J Bone Joint Surg Am 94(18):1700–1711PubMedCrossRefGoogle Scholar
  49. 49.
    Wegrzyn JPV, Chapurlat R, Carret J-P, Béjui-Hugues J, Guyen O (2010) Cementless total hip arthroplasty in Paget’s disease of bone: a retrospective review. Intl Orthop 34(8):1103–1109CrossRefGoogle Scholar
  50. 50.
    Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H, Booth RE, Choong P, Deirmengian C, Ehrlich GD, Gambir A, Huang R, Kissin Y, Kobayashi H, Kobayashi N, Krenn V, Lorenzo D, Marston SB, Meermans G, Perez J, Ploegmakers JJ, Rosenberg A, Simpfendorfer C, Thomas P, Tohtz S, Villafuerte JA, Wahl P, Wagenaar FC, Witzo E (2014) Diagnosis of periprosthetic joint infection. J Orthop Res 32(S 1):98–107Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungschirurgie, Centrum für Muskuloskeletale ChirurgieCharité – Universitätsmedizin BerlinBerlinDeutschland

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