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Der Metall-Metall-Hybridoberflächenersatz des Hüftgelenks

Entwicklung und aktueller Stand

Metal-on-metal hybrid hip resurfacing

Development and current state

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Zusammenfassung

Der Oberflächenersatz am Hüftgelenk gilt heute als weltweit akzeptiertes Verfahren zur knochenschonenden Versorgung von Patienten mit einer Koxarthrose. Durch diese Art der Prothese kann eine anatomische Rekonstruktion und sehr gute Funktion des Gelenks erreicht werden. Ziel des Artikels ist die Darstellung der ersten 1000 Fälle mit der Conserve©-Plus-Hybridoberflächenersatzprothese und die neuesten Entwicklungen auf dem Gebiet der Metall-Metall-Kappengleitpaarungen darzustellen. In einer konsekutiven Studie von 1140 Patienten wurden 1000 Hüftkappenprothesen einem Follow-up von durchschnittlich 5,6 Jahren unterzogen. Die Kaplan-Meier-Überlebensrate der implantierten Oberflächenersatzprothesen betrug 98,1% nach 3 Jahren [95%-Konfidenzintervall (-KI) =96,8–98,9%), 96,7% nach 4 Jahren (95%-KI=94,8–97,8%) und 95,2% nach 5 Jahren (95%-KI=93,0–96,8%) mit dem Endpunkt Konversion in eine reguläre Hüftgelenkprothese. Der Harris-Hip-Score (HHS) stieg postoperativ auf 93,3. Die neue Generation des Metall-Metall-Hybridoberflächenersatzes des Hüftgelenks bringt deutliche Verbesserungen im Vergleich zu Prothesen, die Polyethylenkomponenten verwendeten. Ein Vergleich mit anderen Serien und Gruppen und ein Ausblick auf zukünftige notwendige Untersuchungen im Bereich der Hüftgelenkkappenprothesen wird dargestellt.

Abstract

Worldwide the employment of surface replacements using metal-on-metal components as an option, particularly for the young and active patient, has gained broad acceptance. Part of the attraction for hip resurfacing is its conservative nature as a prosthetic solution for hip arthritis. It is anatomical, replicating the normal hip and limb length, preserving proximal femoral bone, and is a truly minimally bone invasive approach with excellent outcome of joint function. The purpose of this article is to show the data of 1,000 Conserve© Plus hybrid metal-on-metal prostheses in a consecutive study of 1,140 patients with a follow-up of 5.6 years. The current Kaplan and Meier survival estimates of the prosthesis, using any conversion to total hip replacement as the end point, were 98.1% at 3 years [95% confidence interval (CI): 96.8–98.9%], 96.7% at 4 years (95% CI: 94.8–97.8%), and 95.2% at 5 years (95% CI: 93.0–96.8%). The mean postoperative Harris hip score was 93.3. The current state of metal-on-metal surface replacement is positive. The new generation of hip resurfacing has a lot of improvements. The purpose of this review of the procedure is to point out the definite improvements from earlier designs using polyethylene as well as to highlight the overall results and durability achieved by one surgeon’s extensive experience and to assess the results from other series and centers. We also want to point out the areas where further investigation is needed.

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Authors and Affiliations

  1. Joint Replacement Institute, St. Vincent Medical Center, West Third Street, 2200, Los Angeles, Kalifornien, USA

    M. Hoberg, M.J. Le Duff &  H.C. Amstutz

  2. Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, Technische Universität, München, Deutschland

    M. Hoberg

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  1. M. Hoberg
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  2. M.J. Le Duff
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  3. H.C. Amstutz
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Correspondence to H.C. Amstutz.

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Hoberg, M., Le Duff, M. & Amstutz, H. Der Metall-Metall-Hybridoberflächenersatz des Hüftgelenks. Orthopäde 37, 679–684 (2008). https://doi.org/10.1007/s00132-008-1286-5

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  • DOI: https://doi.org/10.1007/s00132-008-1286-5

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