Zusammenfassung
Klinisches Problem
Um die postoperative Bildgebung am Hüftgelenk hinsichtlich möglicher Komplikationen zu beurteilen, sind fundierte Kenntnisse über die unterschiedlichen Operationstechniken, die operativen Zugangswege sowie die verwendeten Fremdmaterialien unerlässlich.
Radiologische Standardverfahren
Während die unmittelbar postoperative Röntgenkontrolle der Beurteilung der korrekten Fremdmateriallage und Gelenkstellung sowie dem Ausschluss intraoperativ entstandener periprothetischer Frakturen dient, geben Verlaufsuntersuchungen Hinweise auf Materialversagen, aseptische Lockerungen, Protheseninfekte oder das Auftreten heterotoper Ossifikationen. Bei unklarem Röntgenbefund kommt die Computertomographie (CT) zur Anwendung, wohingegen die Magnetresonanztomographie (MRT) zur Abklärung intra- und periartikulärer Weichteilpathologien wie operationsassoziierte Knorpel- und Bandschädigungen, Muskelinsuffizienzen und -abrissen oder Metallosen herangezogen wird.
Methodische Innovation und Bewertung
Mit dem Ziel, Handlungs- und Therapieempfehlungen ableiten zu können, stehen zur standardisierten Befundung häufiger postoperativer Komplikationen, wie beispielsweise periprothetischer Frakturen, Prothesenlockerungen oder der Einteilung heterotoper Ossifikationen, unterschiedliche Klassifikationssysteme zur Verfügung. Eine noch zu lösende Herausforderung für die Bildgebung bleibt die sichere Differenzierung aseptischer Materiallockerungen von septischen Protheseninfekten.
Empfehlung für die Praxis
Die Beurteilung der postoperativen Bildgebung der Hüfte sollte eng an die jeweilige Operationstechnik und das eingebrachte Fremdmaterial gekoppelt sein, woraus sich unterschiedliche Auftretenswahrscheinlichkeiten spezifischer Komplikationen ableiten lassen.
Abstract
Clinical issue
To assess postoperative imaging of the hip joint regarding possible complications, it is indispensable to have in-depth knowledge of commonly used surgical techniques, access routes, and the implanted materials.
Standard radiological methods
While radiography is used to evaluate the position of foreign material and to rule out periprosthetic fractures that have occurred intraoperatively, follow-up examinations might show signs of material failure, aseptic loosening, prosthesis infections, or the occurrence of heterotopic ossifications. If radiographic findings are ambiguous, computed tomography (CT) may be used to clarify findings, whereas magnetic resonance imaging (MRI) is helpful to identify intra- and periarticular soft tissue pathologies such as surgery-associated cartilage and ligament damage, muscle insufficiency, or metallosis.
Methodological innovation and evaluation
To guide clinical decision making in common postoperative complications, various classification systems are available, e.g., for periprosthetic fractures, aseptic loosening, or heterotopic ossification. However, the differentiation between aseptic material loosening and septic endoprosthesis infection remains challenging if based on imaging alone.
Practical recommendations
The assessment of postoperative hip imaging should be closely linked to the respective surgical technique and the implanted foreign material, whereby different probabilities of specific complications can be derived.
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M. Armbruster und A. Paulus geben an, dass kein Interessenkonflikt besteht.
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Armbruster, M., Paulus, A. Postoperative Bildgebung des Hüftgelenks. Radiologie 62, 862–869 (2022). https://doi.org/10.1007/s00117-022-01050-2
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DOI: https://doi.org/10.1007/s00117-022-01050-2
Schlüsselwörter
- Hüftprothese
- Endoprothesen
- Hüftgelenkerhaltene Chirurgie
- Postoperative Komplikationen
- Diagnostische Bildgebung