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Arthroskopie

, Volume 31, Issue 4, pp 283–293 | Cite as

Natürlicher Verlauf bei Hüftdysplasie und Operationsergebnisse

Wie ist die Evidenz?
  • K. P. Günther
  • J. Goronzy
  • L. Franken
  • A. Hartmann
  • F. Thielemann
Leitthema
  • 81 Downloads

Zusammenfassung

Hintergrund

Die Prävalenz der Hüftdysplasie liegt in epidemiologischen Studien zwischen 1 und 20 %. Die damit verbundene Deformität gilt als Risikofaktor für sekundäre Koxarthrosen.

Fragestellung

Wie ist der natürliche Verlauf einer Hüftdysplasie und welche Kofaktoren beeinflussen ihn? Wie erfolgreich sind operative Korrekturmaßnahmen?

Material und Methoden

Die in der Literatur bis 2018 publizierten Untersuchungen zum natürlichen Verlauf der Hüftdysplasie und die wichtigsten operativen Behandlungsverfahren wurden analysiert.

Ergebnisse

In der überwiegenden Mehrzahl der publizierten Studien zeigt sich ein Zusammenhang zwischen dem Vorliegen einer Hüftdysplasie und der Entstehung einer Koxarthrose. Je kleiner die Überdachung und je ausgeprägter die Subluxation, desto höher ist das Arthroserisiko. Die Ergebnisse korrigierender Beckenosteotomien sind hinsichtlich Langzeitüberleben und Funktionsverbesserung mittlerweile sehr gut, wenn sie auf Fälle mit guter Gelenkkongruenz im jüngeren/mittleren Lebensalter ohne relevante Arthrose begrenzt werden. Zusätzliche Deformitäten (z. B. Cam-Deformität oder femorale Torsionsfehler) sind mitzubehandeln und eine optimale Reorientierung des Pfannenfragments zu beachten. Zur isoliert arthroskopischen Behandlung einer „Borderline-Dysplasie“ gibt es aktuell nur wenige Untersuchungen mit kleinen Patientengruppen und kurzen Beobachtungszeiten.

Diskussion

Die Bedeutung der Hüftdysplasie als Risikofaktor für sekundäre Koxarthrosen wie auch die guten Ergebnisse von reorientierenden Beckenosteotomien rechtfertigen eine Korrektur bei Beachtung der identifizierten Indikationskriterien. Aufgrund eines zwar geringen, aber relevanten Komplikationspotenzials werden diese Eingriffe dennoch nicht bei beschwerdefreien Patienten im Erwachsenenalter empfohlen. Vermutlich relevante Kofaktoren sind wichtig für die Abschätzung des natürlichen Verlaufs wie auch die Indikationsstellung zur operativen Korrektur.

Schlüsselwörter

Hüfte Deformität Koxarthrose Beckenosteotomie Risikofaktoren 

Natural course of hip dysplasia and results of surgery

What is the evidence?

Abstract

Background

The prevalence of hip dysplasia in epidemiological studies ranges from 1–20%. The associated deformity is a risk factor for secondary osteoarthritis (OA) of the hip.

Objective

What is the natural course of hip dysplasia and is it influenced by cofactors? How successful are corrective surgical procedures?

Material and methods

Analysis of published investigations up to 2018 which provide data about the natural course of hip dysplasia and the results of the most important surgical treatment procedures.

Results

The vast majority of published studies confirm a correlation between hip dysplasia and OA. The risk of OA increases with reduced acetabular coverage and severity of instability (subluxation). Long-term survival and functional results after pelvic osteotomies are meanwhile very good, if the procedure is performed in young or middle-aged patients with good congruency of the joints and no relevant OA. Additional deformities (e. g. cam deformity or femoral torsional malalignment) should be simultaneously addressed and the acetabular fragment needs optimal positioning. Only a few studies with small patient cohorts and short observation times are currently available on the isolated arthroscopic treatment of borderline dysplasia.

Discussion

The importance of hip dysplasia as an established risk factor for secondary OA and the good results of reorientation pelvic osteotomies justify surgical correction when considering the identified indication criteria. Due to a low but relevant potential for complications, surgery should currently not be recommended for asymptomatic patients in adulthood. Potentially relevant cofactors are important for estimation of the natural course as well as the indications for surgical correction.

Keywords

Hips Deformity Coxarthrosis Pelvic osteotomy Risk factors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K.P. Günther, J. Goronzy, L. Franken, A. Hartmann und F. Thielemann geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • K. P. Günther
    • 1
  • J. Goronzy
    • 1
  • L. Franken
    • 1
  • A. Hartmann
    • 1
  • F. Thielemann
    • 1
  1. 1.UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav CarusTechnische Universität DresdenDresdenDeutschland

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