Skip to main content

Advertisement

SpringerLink
Log in

Vorgehen bei schmerzhafter Kappenprothese

Approach to painful hip resurfacing

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Der Oberflächenersatz des Hüftgelenks ist seit 10 Jahren wieder im Fokus der Hüftgelenkendoprothetik. Trotz verbesserter Technologien und Materialien wurden allerdings vermehrt Komplikationen und Lockerungsraten beschrieben. Die Ursachenanalyse von Hüftgelenkschmerzen nach Kappenendoprothetik ist deutlich schwieriger im Vergleich zur Standardendoprothetik und auch für erfahrene Operateure trotz aller diagnostischen Verfahren nicht immer evaluierbar. Eine Reihe spezifischer Ursachen liegt in den speziellen biomechanischen Eigenschaften der verwendeten Materialien und Gleitpaarungen und der speziellen postoperativen Anatomie mit Erhalt der Proportionen von Schenkelhals, Femurkopf und Azetabulum.

Eine präzise Anamnese und klinische Untersuchung sind grundlegend zur Differenzialdiagnostik von Hüftgelenkschmerzen nach Hüftkappenendoprothetik. Röntgenverläufe und knochenszintigraphische Aufnahmen können Hinweise auf aseptische Lockerungen geben. Entzündungsspezifische Laborparameter, mikrobiologische gelenkdiagnostische Maßnahmen und spezielle Leukozytenszintigraphien sind adäquate Verfahren zum Nachweis einer septischen Lockerung. Immunologische Verfahren, Magnetresonanztomographien und auch arthroskopische Verfahren sind bei Verdacht auf metallassoziierte Erkrankungen indiziert. Mechanische Komplikationen wie die Schenkelhalsfraktur oder das femoroazetabuläre Impingement müssen in Bezug auf die Schmerzursache ebenso differenzialdiagnostisch evaluiert werden wie zugangsbedingte Weichteilschädigungen oder seltene Schmerzursachen wie das Psoasimpingement.

Abstract

Hip resurfacing in young patients has been increasingly performed within the last decade. In comparison to standard total hip arthroplasty the failure rate remains high. Age and implant size have a significant effect on the risk of revision for primary total resurfacing and the risk of revision increases with increasing age. At 7 years the cumulative revision rate for patients is 5% and females have more than twice the cumulative revision rate as males. Even in hip resurfacing arthroplasty which has been performed in a perfect manner, a certain percentage of patients suffer from persistent pain for various reasons, such as neck fracture, iliopsoas tendinopathy, metal hypersensitivity, such as aseptic lymphocytic vasculitis associated lesions (ALVAL) and aseptic loosening. Diagnostic work-up of the painful hip resurfacing is challenging even for experienced surgeons. Recommendations for the diagnostic procedure are described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Ala ET, Remy F, Chantelot C, Giraud F et al (2001) Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases. Rev Chir Orthop Reparatrice Appar Mot 87:815–819

    Google Scholar 

  2. Amstutz HC, Beaule PE, Dorey FJ et al (2004) Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg [Am] 86-A:28–39

    Google Scholar 

  3. Amstutz HC, Campbell P, Le Duff MJ (2007) Metal-on-metal hip resurfacing: what have we learned? Instr Course Lect 56:149–161

    PubMed  Google Scholar 

  4. Amstutz HC, Le Duff MJ, Campbell PA et al (2010) Clinical and radiographic results of metal-on-metal hip resurfacing with a minimum ten-year follow-up. J Bone Joint Surg [Am] 92:2663–2671

    Google Scholar 

  5. Bader R, Kluss D, Gerdesmeyer L et al (2008) Biomechanical aspects of the implant fixation and kinematics of hip resurfacing systems. Orthopade 37:634–643

    Article  PubMed  CAS  Google Scholar 

  6. Beaule PE, Campbell P, Amstutz HC (2000) Metallosis and metal-on-metal bearings. J Bone Joint Surg [Am] 82:751–752

    Google Scholar 

  7. Beaule PE, Campbell PA, Hoke R et al (2006) Notching of the femoral neck during resurfacing arthroplasty of the hip: a vascular study. J Bone Joint Surg [Br] 88:35–39

    Google Scholar 

  8. Berbari E, Mabry T, Tsaras G et al (2010) Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg [Am] 92:2102–2109

    Google Scholar 

  9. Braunstein EM, Cardinal E, Buckwalter KA et al (1995) Bupivicaine arthrography of the post-arthroplasty hip. Skeletal Radiol 24:519–521

    Article  PubMed  CAS  Google Scholar 

  10. Browne JA, Bechtold CD, Berry DJ et al (2010) Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res 468:2313–2320

    Article  PubMed  Google Scholar 

  11. Buergi ML, Walter WL (2007) Hip resurfacing arthroplasty: the Australian experience. J Arthroplasty 22:61–65

    Article  PubMed  Google Scholar 

  12. Campbell P, Beaule PE, Ebramzadeh E et al (2006) The John Charnley Award: a study of implant failure in metal-on-metal surface arthroplasties. Clin Orthop Relat Res 453:35–46

    Article  PubMed  Google Scholar 

  13. Campbell P, Shimmin A, Walter L et al (2008) Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty 23:1080–1085

    Article  PubMed  Google Scholar 

  14. Carrothers AD, Gilbert RE, Jaiswal A et al (2010) Birmingham hip resurfacing: the prevalence of failure. J Bone Joint Surg [Br] 92:1344–1350

    Google Scholar 

  15. Bin Nasser A, Beaulé PE, O’Neill M et al (2010) Incidence of groin pain after metal-on-metal hip resurfacing. Clin Orthop Relat Res 468:392–399

    Article  Google Scholar 

  16. Fink B, Grossmann A, Fuerst M et al (2009) Two-stage cementless revision of infected hip endoprostheses. Clin Orthop Relat Res 467:1848–1858

    Article  PubMed  Google Scholar 

  17. Fink B, Makowiak C, Fuerst M et al (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg [Br] 90:874–878

    Google Scholar 

  18. Fuerst M, Fink B, Ruther W (2005) The value of preoperative knee aspiration and arthroscopic biopsy in revision total knee arthroplasty. Z Orthop Ihre Grenzgeb 143:36–41

    Article  PubMed  CAS  Google Scholar 

  19. Gerdesmeyer L, Gollwitzer H, Diehl P et al (2009) The minimally invasive anterolateral approach combined with hip onlay resurfacing. Oper Orthop Traumatol 21:65–76

    Article  PubMed  Google Scholar 

  20. Ghanem E, Antoci V Jr, Pulido L et al (2009) The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty. Int J Infect Dis 13:e444–e449

    Article  PubMed  CAS  Google Scholar 

  21. Ghanem E, Azzam K, Seeley M et al (2009b) Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation? Clin Orthop Relat Res 467:1699–1705

    Article  PubMed  Google Scholar 

  22. Glyn-Jones S, Pandit H, Kwon YM et al (2009) Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg [Br] 91:1566–1574

    Google Scholar 

  23. Huo MH, Salvati EA, Lieberman JR et al (1992) Metallic debris in femoral endosteolysis in failed cemented total hip arthroplasties. Clin Orthop Relat Res 276:157–168

    PubMed  Google Scholar 

  24. Johnston CA, Wiley JP, Lindsay DM et al (1998) Iliopsoas bursitis and tendinitis. A review. Sports Med 25:271–283

    Article  PubMed  CAS  Google Scholar 

  25. Kluess D, Zietz C, Lindner T et al (2008) Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter. Acta Orthop 79:748–754

    Article  PubMed  Google Scholar 

  26. Lavigne M, Rama KR, Roy A et al (2008) Painful impingement of the hip joint after total hip resurfacing: a report of two cases. J Arthroplasty 23:1074–1079

    Article  PubMed  Google Scholar 

  27. Levitsky KA, Hozack WJ, Balderston RA et al (1991) Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration. J Arthroplasty 6:237–244

    Article  PubMed  CAS  Google Scholar 

  28. Lieberman JR, Huo MH, Schneider R et al (1993) Evaluation of painful hip arthroplasties. Are technetium bone scans necessary? J Bone Joint Surg [Br] 75:475–478

    Google Scholar 

  29. Merkel KD, Brown ML, Dewanjee MK et al (1985) Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. A prospective study. J Bone Joint Surg [Am] 67:465–476

    Google Scholar 

  30. Morlock MM, Bishop N, Ruther W et al (2006) Biomechanical, morphological, and histological analysis of early failures in hip resurfacing arthroplasty. Proc Inst Mech Eng H 220:333–344

    PubMed  CAS  Google Scholar 

  31. Morlock MM, Bishop N, Zustin J et al (2008) Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens. J Bone Joint Surg [Am] 90(suppl 3):89–95

    Google Scholar 

  32. Pandit H, Glyn-Jones S, McLardy-Smith P et al (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg [Br] 90:847–851

    Google Scholar 

  33. Rudert M, Gerdesmeyer L, Rechl H et al (2007) Resurfacing arthroplasty of the hip. Orthopade 36:304–310

    Article  PubMed  CAS  Google Scholar 

  34. Shimmin A, Beaule PE, Campbell P (2008) Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg [Am] 90:637–654

    Google Scholar 

  35. Shimmin AJ, Bare J, Back DL (2005) Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am 36:187–93

    Article  PubMed  CAS  Google Scholar 

  36. Shimmin AJ, Walter WL, Esposito C (2010) The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip: a review of the literature. J Bone Joint Surg [Br] 92:469–476

    Google Scholar 

  37. Thomas P, Thomsen M (2008) Allergy diagnostics in implant intolerance. Orthopade 37:131–135

    Article  PubMed  CAS  Google Scholar 

  38. Thomas P, Thomsen M (2010) Implant allergies. Hautarzt 61:255–262

    Article  PubMed  CAS  Google Scholar 

  39. Wagner H (1978) Surface replacement arthroplasty of the hip. Clin Orthop Relat Res 134:102–130

    PubMed  Google Scholar 

  40. Wagner M, Wagner H (1996) Preliminary results of uncemented metal on metal stemmed and resurfacing hip replacement arthroplasty. Clin Orthop Relat Res 329:S78–S88

    Article  PubMed  Google Scholar 

  41. Willert HG, Buchhorn GH, Fayyazi A et al (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg [Am] 87:28–36

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Sektion onkologische und rheumatologische Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße, 24105, Kiel, Deutschland

    L. Gerdesmeyer & M. Fuerst

  2. Klinikum rechts der Isar, TU München, München, Deutschland

    H. Gollwitzer

  3. Orthopädische Klinik, Universitätsklinikum Rostock, Rostock, Deutschland

    P. Diehl

  4. Orthopädiezentrum München-Ost, Grafing, Deutschland

    P. Diehl

  5. Fachklinik für Orthopädie, Traumatologie und Sportmedizin, Bernau-Felden, Deutschland

    M. Schmitt-Sody

Authors
  1. L. Gerdesmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Gollwitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Diehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Fuerst
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Schmitt-Sody
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Gerdesmeyer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gerdesmeyer, L., Gollwitzer, H., Diehl, P. et al. Vorgehen bei schmerzhafter Kappenprothese. Orthopäde 40, 481–490 (2011). https://doi.org/10.1007/s00132-011-1757-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-011-1757-y

Schlüsselwörter

Keywords

Search

Navigation