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Hüftkopfdurchblutung und Resurfacing

Blood flow to the femoral head and hip resurfacing arthroplasty

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Zusammenfassung

Mit der Einführung von Metall-Metall-Gleitpaarungen hat der Oberflächenersatz an der Hüfte eine Renaissance erlebt, da implantatverursachte Probleme, insbesondere abriebsbedingte Osteolysen, gelöst erscheinen. Nicht gelöst sind jedoch weiterhin die Probleme der Schenkelhalsfrakturen, Schenkelhalsschwund und Kappenlockerungen, deren Ursachen kontrovers diskutiert werden. In den letzten Jahren hat sich zunehmende Evidenz dafür ergeben, dass sowohl der häufig gebrauchte dorsale Zugang zum Hüftgelenk aber auch die Präparation des Epiphysenstumpfes die Durchblutung des Hüftkopfes kritisch schädigen und damit die Knochenbiologie kompromittieren können. Kommt mechanischer Stress (Impaktierung, Hitzeentwicklung beim Zementieren) während der Implantation hinzu, so kann dies vom präparierten Femurende nicht mehr kompensiert werden. Diese Arbeit fasst den heutigen Kenntnisstand zur Durchblutung des Femurkopfes zusammen und stellt ein Konzept vor diese auch nach einem Oberflächenersatz zu erhalten.

Abstract

After disastrous outcomes due to wear-induced osteolysis in the 1980s, hip resurfacing arthroplasty has undergone a renaissance, mainly because of the introduction of metal-on-metal bearings. However, there are still problems associated with this technique, such as femoral neck fractures, neck thinning, and aseptic loosening, and their causes are still being investigated. During the last years, increasing evidence has shown that both the frequently used posterior approach to the hip as well as preparation of the femoral epiphysis can impair blood supply to the femoral head. In the presence of mechanical stresses (impaction, heat development during cement polymerization) during the implantation, the epiphysis might not be able to compensate for this. This paper summarizes the current understanding of the blood supply to the femoral head and proposes a way to preserve the viability after hip resurfacing.

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Danksagung

Die Abbildungen 1 und 3a basieren auf der Dissertation von Katharina Ganz und Nathalie Krügel.

Interessenskonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Paul E. Beaulé ist Berater der Firma Wright Medical. Reinhold Ganz und Michael Leunig sind Berater der Firma Plus Orthopedics (heute Teil von Smith & Nephew). Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery,Head Adult Reconstruction Service, University of Ottawa, Ottawa Hospital – General Campus, Critical Care Wing 1646, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada

    P.E. Beaulé

  2. Medizinische Fakultät, Universität, Bern, Schweiz

    R. Ganz & M. Leunig

  3. Orthopädie, Hüftchirurgie, Schulthess-Klinik, Zürich, Schweiz

    M. Leunig

Authors
  1. P.E. Beaulé
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  2. R. Ganz
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  3. M. Leunig
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Correspondence to P.E. Beaulé.

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Beaulé, P., Ganz, R. & Leunig, M. Hüftkopfdurchblutung und Resurfacing. Orthopäde 37, 659–666 (2008). https://doi.org/10.1007/s00132-008-1300-y

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