Der Orthopäde

, Volume 46, Issue 11, pp 928–937 | Cite as

Knorpelregenerative Eingriffe am Hüftgelenk

Was ist machbar?
  • Stefan Landgraeber
  • Marcus Jäger
  • Stefan Fickert
Leitthema
First Online:

Zusammenfassung

Lokalisierte Knorpelschäden am Hüftgelenk werden hauptsächlich durch präarthrotische Deformitäten, insbesondere durch das femoroazetabuläre Impingement (FAI) vom Typ Cam ausgelöst. Die vorzeitige Beseitigung symptomatischer Deformitäten kann die Progredienz lokalisierter Knorpelschäden verhindern. Diese sind meist am anterolateralen Acetabulum lokalisiert und können sowohl offen als auch arthroskopisch versorgt werden. Zur Behandlung eignen sich knochenmarkstimulierende Verfahren mit und ohne Applikation von Biomaterialien sowie die autologe Knorpelzelltransplantation. In ausgewählten Fällen kann durch biologische Maßnahmen der Versuch der Readaption des geschädigten Knorpels vorgenommen werden. Im vorliegenden Artikel wird die aktuelle Studienlage zu den genannten Verfahren näher beleuchtet und ein Ausblick auf mögliche zukünftige Verfahren gegeben.

Schlüsselwörter

Acetabulum Arthroskopie Autologe Knorpelzelltransplantation Chondroblasten Mikrofrakturierung 

Abkürzungen

ACT

Autologe Knorpelzelltransplantation

AMIC

Autologe matrixinduzierte Chondrogenese

ATMP

Arzneimittel für neuartige Therapien

BM-MNC

Bone marrow mononuclear cells

CE-Winkel

Centrum-Ecken-Winkel

CPM

„Continuous passive motion“

DDH

„Developmental dysplasia of the hip“

DGOU

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

FAI

Femoroazetabuläres Impingement

HOS

Hip Outcome Score

KMV

Knochenmarkstimulierende Verfahren

MACT

Matrixgekoppelte autologe Knorpelzelltransplantation

MFx

Mikrofrakturierung

mHHS

Modified Harris Hip Score

MOCART

„Magnetic resonance observation of cartilage repair tissue“

MPZ

Mesenchymale Progenitorzellen

NAHS

Non-Arthritic Hip Score

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index

Cartilage regeneration surgery on the hip

What is feasible?

Abstract

Localized cartilage defects at the hip are mainly caused by pre-arthritic deformities, particularly by cam-type femoroacetabular impingement (FAI). Timely elimination of symptomatic deformities can prevent further progression such as cartilage defects. As the defects mostly occur in the anterolateral part of the acetabulum, they can be easily treated either by open surgery or by arthroscopy. To date the most effective methods of treatment are bone marrow stimulation, with or without a covering of biomaterials, and autologous chondrocyte transplantation. In selected cases, readaptation of the damaged cartilage can be attempted by biological procedures. In the present article, the findings reported in current studies on these procedures are summarized and discussed in detail. An outlook is given regarding possible future treatment concepts.

Keywords

Acetabulum Arthroscopic surgery Autologous chondral transplantation Chondroblasts Microfractures 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Landgraeber gibt an, dass er dreimal eine Aufwandsentschädigung für Vorträge von B. Braun erhalten hat, S. Fickert gibt einen Beratervertrag bei Tetec/B. Braun und Codon an. M. Jäger gibt an, dass kein Interessenkonflikt besteht.

Zur Erstellung des Beitrages wurden durch die Autoren keine Untersuchungen an Menschen und Tieren durchgeführt.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • Stefan Landgraeber
    • 1
  • Marcus Jäger
    • 1
  • Stefan Fickert
    • 2
    • 3
  1. 1.Klinik für Orthopädie und UnfallchirurgieUniversitätsklinikum Essen, Universität Duisburg-EssenEssenDeutschland
  2. 2.Medizinische Fakultät MannheimUniversität HeidelbergMannheimDeutschland
  3. 3.sporthopaedicum Straubing/RegensburgStraubingDeutschland

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