Zusammenfassung
Pro Jahr werden in Deutschland ca. 190.000 Hüftendoprothesen implantiert. Durch die Verbesserung der Implantate und die Weiterentwicklung moderner Operationstechniken und -instrumente ist die prozentuale Lockerungsrate deutlich reduziert worden. Die Standzeiten der Implantate konnten in den letzten Jahren weiter erhöht werden, jedoch klagen bis zu 22% der Patienten nach Hüftprothesenimplantation über persistierende Schmerzen. Die Diagnostik bestehender Schmerzen nach endoprothetischer Versorgung des Hüftgelenks und die sich daraus ergebende kausale Therapie fordern aufgrund der Heterogenität der Ursachen eine systematische Vorgehensweise. Die Ätiologie der Schmerzen kann gelenkassoziiert als auch hüftgelenkunabhängig sein. Oft sind die Schmerzursachen multifaktoriell, sodass eine standardisierte Diagnostik anhand eines Algorithmus durchgeführt werden sollte. Die Klärung der Schmerzen beginnt mit der Anamnese, Inspektion, Palpation und wird gefolgt von der klinischen Untersuchung. Es schließen sich Bildgebung und falls erforderlich invasive Verfahren an. Die explorative Revision wird heutzutage in der Literatur als obsolet angesehen. In der vorliegenden Arbeit wird ein Algorithmus vorgestellt, mit dem man die Ursache der Schmerzen zielgerichtet erheben kann.
Abstract
The number of implantations of hip prostheses in Germany is now approximately 190,000 per year. By improving the implants and the development of modern surgical techniques and instruments the revision rate has been significantly reduced. The survival rate of the implants could be further increased in recent years, however, up to 22% of patients complain about persistent pain after hip arthroplasty. The diagnosis of existing pain after total joint replacement of the hip joint to achieve a causal therapy needs a systematic approach because of the heterogeneity of the symptoms and diseases. The etiology of the pain can be joint-associated and also hip joint independent. Often the causes of pain are multifactorial so that a standardized assessment should be conducted using an algorithm. The clarification of pain begins with the history, inspection and palpation followed by a clinical examination. It is then useful to perform radiological imaging followed by invasive procedures if necessary. The exploratory revision is nowadays considered to be obsolete in the literature.
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Hoberg, M., Holzapfel, B. & Rudert, M. Schmerzhafte Hüftendoprothetik. Orthopäde 40, 474–480 (2011). https://doi.org/10.1007/s00132-011-1756-z
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DOI: https://doi.org/10.1007/s00132-011-1756-z