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Revisionschirurgie des Oberflächenersatzes

Revision surgery of hip resurfacing

  • Leitthema
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Zusammenfassung

Mittlerweile werden weltweit bis zu 20% der primären Hüftendoprothesen als Oberflächenersätze implantiert. Langfristige Behandlungsergebnisse stehen zwar noch aus, doch scheinen die bisherigen Untersuchungen darauf hinzudeuten, dass, im Vergleich zu historischen Vorläufermodellen, mit den modernen Implantaten (Metall-Metall-Gleitpaarung) und exakter Operationstechnik deutlich bessere Resultate – zumindest kurz- und mittelfristig – erzielbar sind.

Ein häufig genannter Vorteil der Oberflächenersatzendoprothetik ist die angeblich gute Voraussetzung für Revisionseingriffe aufgrund einer sparsamen Knochenresektion beim Ersteingriff. Dazu gibt es in der verfügbaren Literatur bislang jedoch kaum fundierte Daten, da die Zahl der systematisch ausgewerteten Komplikationen noch zu gering ist. Unsere eigenen Erfahrungen deuten darauf hin, dass die isolierte Revision des femoralen Implantats (z. B. bei Schenkelhalsfraktur oder aseptischer Kappenlockerung) tatsächlich wenig aufwendig ist. Welche Bedeutung dabei jedoch einem möglichen Abrieb knöchern fest integrierter Pfannenkomponenten zukommt, kann derzeit noch nicht abgeschätzt werden.

Auf Pfannenseite wird der Revisionsaufwand in identischer Weise wie bei der konventionellen Endoprothetik vom Zustand des knöchernen Lagers beeinflusst. Die Möglichkeit zum isolierten Inlaywechsel besteht jedoch bei den meisten verfügbaren Oberflächenersatzmodellen nicht. Insgesamt sollte deshalb das Argument einer guten Rückzugsmöglichkeit beim Oberflächenersatz nicht unkritisch genutzt werden.

Abstract

Early results of contemporary hip resurfacing are encouraging and consequently an increasing number of this procedure has been performed worldwide. A theoretical advantage of hip resurfacing is that failed components can be revised safely and successfully revised to a conventional total hip arthroplasty. As the number of systematically analyzed failures is still limited, however, current data from the literature cannot substantially support this assumption.

Our personal results indicate that the conversion of a failed femoral cup (i.e., due to neck fracture or aseptic loosening) to a conventional stem is a relatively simple and safe procedure. If and how potential wear of a firmly integrated acetabular component might have any impact on this type of revision, warrants further investigations.

The conversion of acetabular components is influenced by the quality of the remaining pelvic bone stock and can therefore be compared to conventional revision surgery. However, as most providers of hip resurfacings systems only offer one-piece acetabular shells, the possibility of an isolated modular insert exchange is rare. In conclusion, the argument of easy revision surgery after hip resurfacing should be used with care.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Unterstützung von Forschungsprojekten durch Fa. Zimmer und Fa. Smith & Nephews. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    K.-P. Günther, M. Stiehler & S. Kirschner

  2. Forum Gesundheit, Belegabteilung für Orthopädie, Krankenhaus St. Joseph-Stift, Dresden, Deutschland

    W.-C. Witzleb

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  1. K.-P. Günther
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  2. W.-C. Witzleb
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  3. M. Stiehler
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  4. S. Kirschner
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Correspondence to K.-P. Günther.

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Günther, KP., Witzleb, WC., Stiehler, M. et al. Revisionschirurgie des Oberflächenersatzes. Orthopäde 37, 685–694 (2008). https://doi.org/10.1007/s00132-008-1284-7

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