Zusammenfassung
Aktuelle Versagensanalysen zum Oberflächenersatz des Hüftgelenks zeigen, dass eine tiefe Zementpenetration und ein unvollständiger Prothesensitz mit Prothesenlockerungen und Schenkelhalsbrüchen assoziiert sind. In den wenigen bisher durchgeführten Studien zeigt sich, dass die Zementiertechnik einen starken Einfluss auf den resultierenden Zementdruck, die Temperatur im Interface und die Zementpenetrationstiefe hat. Zementiertechniken unter Zementfüllung der Prothesenkappe zeigen eine tiefe femorale Zementpenetration bei gleichzeitig zu wenig Zement distal-lateral und einem Risiko für einen unvollständigen Prothesensitz. Dies geht mit Temperaturen im Zement-Knochen-Interface einher, die hoch genug sind, das Knochengewebe irreversibel zu schädigen. Die Handapplikation mit hochviskösem Zement, ähnlich der Zementierung einer Knie TEP, führt dagegen zu einer gleichmäßigen ca. 3 mm tiefen Zementpenetration in der äußeren Verankerungszone, ohne die negativen Effekte einer Zementüberladung auszulösen.
Abstract
In recent retrieval studies, overpenetration of cement, incomplete seating of the prosthesis with a resulting polar cement mass, or both have been associated with failure of current-generation femoral resurfacing arthroplasties. Cementing technique was found to strongly influence cement pressure, interface temperature, and cement penetration in the few cementing studies published on hip resurfacing arthroplasty. Component-filling cementing techniques resulted in a risk of incomplete seating, variable degrees of overpenetration of the interior area, and a lack of cement at the outer lower edges of the bone under the resurfacing components. This caused exposure to high temperatures, which can cause bone necrosis. The manual technique with high-viscosity cement showed advantages in our experimental work. It was possible to achieve high cement contents in the outer fixation area without the negative effects of interior area penetration.
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Bitsch, R., Schmalzried, T. Die femorale Zementiertechnik für den Oberflächenersatz des Hüftgelenks. Orthopäde 37, 667–671 (2008). https://doi.org/10.1007/s00132-008-1299-0
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DOI: https://doi.org/10.1007/s00132-008-1299-0