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Zugangswege zum Oberflächenersatz am Hüftgelenk

Surgical approaches in hip resurfacing

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Zusammenfassung

Im Rahmen der Standardendoprothetik sind eine Reihe von Zugangswegen beschrieben worden, die sich im Wesentlichen aus drei verschiedenen operativen Techniken entwickelt haben. Hierbei handelt es sich um den anterioren, den anterolateralen und den dorsalen Zugang. Bedingt durch die Instrumentation bei der Präparation zur Implantation eines Oberflächenersatzes werden dorsale Zugänge derzeit favorisiert. Während beim dorsalen Zugang das Acetabulum leichter darzustellen ist, ist das Risiko einer Verletzung der den Kopf versorgenden Gefäße bei vorderen Zugängen deutlich geringer. Ein begleitendes ventrales femoroazetabuläres Impingement ist leichter über vordere Zugänge zu beseitigen. Durch spezielle Modifikationen des vorderen Zugangs und Verwendung anatomisch ausgerichteter Implantate und Instrumente ist der Oberflächenersatz über einen anterolateralen Zugang auch in minimal-invasiver Technik möglich. Sehr gute klinische und funktionelle Ergebnisse nach Kappenendoprothetik sind über anteriore, anterolaterale und auch dorsale Zugänge erzielbar.

Abstract

A large variety of approaches are described for standard total hip arthroplasty. All of them are technically based on three different approaches: anterior, anterolateral, or posterior. In recent hip resurfacing, the posterior approach is common, due to large instruments used to ream the femur. Better exposure of the acetabulum is achieved by the posterior approach, but this technique puts the important extraosseous blood supply to the femoral head at risk. The anterior approach preserves blood supply and gives better options to treat the femoroacetabular impingement. If specific surgical modifications and instruments designed for minimally invasive surgery are used, hip resurfacing can be performed with an anterolateral technique. Excellent functional and clinical outcomes have been reported after all three approaches.

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Authors and Affiliations

  1. Department für Endoprothetik und Wirbelsäulenchirurgie, Mare-Klinikum, Eckernförder Straße 219, 24119, Kiel-Kronshagen, Deutschland

    L. Gerdesmeyer

  2. Klinik für Orthopädie und Unfallchirurgie, Technische Universität München, München, Deutschland

    H. Gollwitzer & M. Rudert

  3. Klinik für Orthopädie, Universität, Rostock, Deutschland

    R. Bader

Authors
  1. L. Gerdesmeyer
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  2. H. Gollwitzer
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  3. R. Bader
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  4. M. Rudert
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Correspondence to L. Gerdesmeyer.

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Gerdesmeyer, L., Gollwitzer, H., Bader, R. et al. Zugangswege zum Oberflächenersatz am Hüftgelenk. Orthopäde 37, 650–658 (2008). https://doi.org/10.1007/s00132-008-1282-9

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