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Synoviale Erkrankungen und freie Körper des Hüftgelenks

Arthroskopische Diagnostik und Therapie

Synovial disorders and loose bodies in the hip joint

Arthroscopic diagnostics and treatment

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Zusammenfassung

Synoviale Erkrankungen und freie Gelenkkörper zählen zu den häufigsten Indikationen der Hüftarthroskopie. In der Literatur werden arthroskopische Operationen am Hüftgelenk bei freien Gelenkkörpern, synovialen Plicae, der synovialen Chondromatose, der pigmentierten villonodulären Synovialitis (PVNS) sowie bei rheumatoider und septischer Arthritis beschrieben.

Ein wesentlicher Vorteil gegenüber bildgebenden diagnostischen Verfahren besteht in der Möglichkeit zur einzeitigen Inspektion, Biopsie und chirurgischen Intervention. Im Vergleich zur Arthrotomie wird die ausgedehnte chirurgische Exploration, die mit einer höheren Morbidität und längerer Rehabilitation verbunden ist, vermieden. Dennoch ist ein kurativer Einsatz der Hüftarthroskopie nicht bei allen synovialen Erkrankungen möglich. Während bei freien Gelenkkörpern, synovialen Plicae, der initialen septischen Arthritis und mit Einschränkungen bei der PVNS eine kausale Therapie und eine „Restitutio ad integrum“ erreicht werden können, ist die Indikation der Hüftarthroskopie bei der synovialen Chondromatose und der rheumatoiden Arthritis in der Diagnostik und symptomatischen Therapie zur Reduzierung der Beschwerden und Erhalt bzw. Verbesserung der Gelenkfunktion zu sehen. Der Erfolg hängt maßgeblich von der richtigen Indikationsstellung und einer korrekten Operationstechnik ab.

Abstract

Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis.

One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and “restitutio ad integrum” can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.

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  1. Klinik für Orthopädie und orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar

    S. Gödde, M. Kusma & M. Dienst

  2. Klinik für Orthopädie und orthopädische Chirurgie, Universitätskliniken des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar

    S. Gödde

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  1. S. Gödde
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Correspondence to S. Gödde.

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Gödde, S., Kusma, M. & Dienst, M. Synoviale Erkrankungen und freie Körper des Hüftgelenks. Orthopäde 35, 67–76 (2006). https://doi.org/10.1007/s00132-005-0894-6

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