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Zementfreier Femurschaftwechsel mit einem modularen Hüftendoprothesenrekonstruktionsschaft

Modular noncemented femoral stem system in revision total hip arthroplasty

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Zusammenfassung

Hintergrund

Die Hüftschaftlockerung geht in den meisten Fällen mit periprothetischen Osteolysen einher. Es werden die kurzfristigen klinischen und radiologischen Ergebnisse nach Schaftwechsel bei Knochensubstanzdefekten am Femur mit dem modularen zementfreien LINK-MP-Rekonstruktionsschaft dargestellt.

Patienten und Methoden

Im Zeitraum von März 2003 bis November 2005 wurden bei 90 Patienten 91 LINK-MP-Rekonstruktionsschäfte implantiert. Bei einem durchschnittlichen Nachuntersuchungszeitraum von 16,7±6,5 (6–36) Monaten konnten 81 Wechseloperationen (51 Schaftwechsel, 24 komplette Prothesenwechsel und 6 Reimplantationen bei Girdlestone-Hüfte) prospektiv ausgewertet werden. Das durchschnittliche Patientenalter lag bei 67,2±10,5 (31–87) Jahren.

Ergebnisse

Die Beurteilung der Knochensubstanzdefekte am proximalen Femur nach Paprosky ergab einen Typ 2 in 5 Fällen, einen Typ 3A in 73 Fällen und einen Typ 3B in 3 Fällen. Der Merle d’Aubigné-Score stieg signifikant von präoperativ 10,4±2,3 (4–15) auf 14,7±2,2 (9–18) Punkte in der Nachuntersuchung an (p<0,001). Nativ-radiologisch kam es bei der Migrationsanalyse des Schaftes zu einem durchschnittlichen Einsinken von 3,4 mm. Es wurden 31 intra- und postoperative Komplikationen bei 28 (34,5%) Patienten erhoben.

Schlussfolgerung

Der LINK-MP-Rekonstruktionsschaft hat sich im klinischen Gebrauch bei Revisionen mit einem proximalen Femurdefekt im Kurzzeitverlauf als zuverlässig erwiesen. Die Ergebnisse sind mit den Ergebnissen anderer modularer zementfreier Hüftendoprothesenschäfte vergleichbar. Im Vergleich zur Primärendoprothetik sind die Komplikationen erwartungsgemäß erhöht.

Abstract

Background

In most cases, loosening of a prosthesis stem is accompanied by periprosthetic osteolysis. This article presents the short-term clinical and radiological results after revision of total hip arthroplasty (THA) with bone substance deficiencies using a modular noncemented femoral stem system (LINK MP).

Patients and methods

Between March 2003 and November 2005, 91 LINK MP modular revision stems were implanted in 90 patients. Eighty-one patients (51 stem revisions, 24 revisions of stem and shell, and six reimplantations after a Girdlestone situation) were available for prospective clinical and radiological evaluation at an average follow-up time of 16.7±6.5 (6–36) months. The average patient age at revision was 67.2±10.5 (31–87) years.

Results

Bone defects in the proximal femur were evaluated according to the Paprosky classification and showed type 2 in five cases, type 3A in 73 cases, and type 3B in three cases. The Merle d’Aubigné score increased significantly from 10.4±2.3 (4–15) preoperatively to 14.7±2.2 (9–18) at the latest follow-up (p<0.001). Migration analysis in conventional radiographs revealed an average stem subsidence of 3.4 mm. Thirty-one intraoperative and postoperative complications were noted in 28 (34.5%) patients.

Conclusion

After a short-term follow-up, the modular noncemented femoral stem system LINK MP was shown to be a reliable tool for revision of THA with bony defects of the proximal femur. Our results are comparable to those for other modular noncemented revision stems. As expected, complication rates were higher than with primary THA.

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Authors and Affiliations

  1. Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    M.D. Schofer, T. Efe, T.J. Heyse, R. Velte, F. Hinrichs & J. Schmitt

  2. Institut für Medizinische Biometrie und Epidemiologie, Philipps-Universität, Marburg, Deutschland

    N. Timmesfeld

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  1. M.D. Schofer
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  2. T. Efe
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  6. F. Hinrichs
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  7. J. Schmitt
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Correspondence to M.D. Schofer.

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Schofer, M., Efe, T., Heyse, T. et al. Zementfreier Femurschaftwechsel mit einem modularen Hüftendoprothesenrekonstruktionsschaft. Orthopäde 39, 209–216 (2010). https://doi.org/10.1007/s00132-009-1514-7

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