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Versagensgründe von Oberflächenersatzimplantaten der Hüfte

Eine Analyse von 250 Revisionspräparaten

Reasons for failure of hip resurfacing implants

A failure analysis based on 250 revision specimens

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Zusammenfassung

Die Wiedereinführung des Oberflächenersatzes hat zu einer überraschend schnellen Reetablierung dieses Verfahrens nach den unbefriedigenden Ergebnissen in der Vergangenheit geführt. Die relativ hohe Rate an Frühversagern gibt jedoch noch Anlass zu Bedenken. Im Rahmen der vorliegenden Studie wurden 256 Revisionspräparate tribologisch, radiologisch, morphologisch und histologisch analysiert, um Ursachen für das Versagen bzw. die Revision zu identifizieren. Mehr als zwei Drittel der Versager wurden aufgrund einer Fraktur revidiert – Halsfrakturen traten hierbei deutlich früher auf als Fakturen innerhalb des Kopfes und Pfannenlockerungen. Die Versagensrate war innerhalb der ersten 16 Wochen nach Implantation und bei den ersten 10 Operationen eines Operateurs am höchsten. Revisionen ohne Vorliegen einer Fraktur oder Pfannenlockerung erfolgten im Durchschnitt nach 2 Jahren. Revisionen, bedingt durch femurseitige Probleme wie Notching oder überhöhte Implantationskräfte, traten vor pfannenseitigen Problemen wie Pfannenlockerung oder erhöhtem Verschleiß durch Pfannenfehlpositionierung auf. Die Anteversion der Pfanne spielt hierbei eine wichtige Rolle, die im Rahmen der Studie jedoch nicht quantifiziert werden konnte.

Abstract

Hip resurfacing has been experiencing a revival over the last 5–10 years. Early failure rates are higher than for conventional primary hip arthroplasty. Fractures of the femoral neck or head, cup loosening and persistent pain are the most frequently observed reasons for early revision. In this international retrospective uncontrolled study, 256 revision specimens (219 resurfacing heads, 37 cups) were analysed radiologically, tribologically, morphologically and histologically in order to investigate the failure mechanism. Of the head revisions, 70% were due to neck (median: 67 days after implantation) and head fractures (161 days), 9% were due to cup loosening (350 days) and 21% due to other reasons (602 days). Implants with rim loading (22% of all retrievals, cup inclination 58.0±10.9°) exhibited a head wear rate of 7.1±5.2 mm³/year. Non-rim loaded implants exhibited a head wear rate of 0.24±0.53 mm³/year (cup inclination 49.0±4.0°). The failure rate was highest during the first 16 weeks after surgery and for the first ten operations performed by a surgeon. Revisions based on problems on the femoral side such as notching and high implantation forces occurred earlier than revisions based on problems on the acetabular side such as cup loosening and high wear due to suboptimal cup position.

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Danksagung

Diese Studie wurde von der Behörde für Gesundheit und Soziales der Freien und Hansestadt Hamburg sowie den Firmen Biomet, Corin, DePuy, Smith & Nephew sowie Zimmer finanziell unterstützt.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Analyse der Implantate wurde von den Firmen Biomet, Corin, DePuy, Smith & Nephew sowie Zimmer finanziell unterstützt. Referenztätigkeiten für Ceramtec, DePuy, Biomet, Zimmer und Smith & Nephew. Es besteht kein Interessenkonflikt. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Institut für Biomechanik, TU Hamburg-Harburg, Denickestraße 15, 21073, Hamburg, Deutschland

    M.M. Morlock PhD, N. Bishop & F. Stahmer

  2. Universitätsklinikum Eppendorf, Hamburg, Deutschland

    J. Zustin, G. Sauter, M. Hahn, M. Krause, W. Rüther & M. Amling

Authors
  1. M.M. Morlock PhD
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  2. N. Bishop
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  3. F. Stahmer
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  4. J. Zustin
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  5. G. Sauter
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  6. M. Hahn
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  7. M. Krause
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  8. W. Rüther
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  9. M. Amling
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Corresponding author

Correspondence to M.M. Morlock PhD.

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Morlock, M., Bishop, N., Stahmer, F. et al. Versagensgründe von Oberflächenersatzimplantaten der Hüfte. Orthopäde 37, 695–703 (2008). https://doi.org/10.1007/s00132-008-1298-1

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  • DOI: https://doi.org/10.1007/s00132-008-1298-1

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