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Vermeidung, Diagnostik und Therapie von Nervenläsionen nach Hüftendoprothesenimplantation

Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty

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Zusammenfassung

Nervenschäden nach endoprothetischer Versorgung des Hüftgelenks stellen eine seltene Komplikation dar. Es besteht eine Reihe von Risiken (Hüftdysplasie, Zustand nach Frakturversorgung, Begleiterkrankungen), bei denen eine erhöhte Rate an Nervenschäden zu erwarten ist. Durch sorgfältige Vorbereitung und schonende Operationsdurchführung kann in den meisten Fällen eine Nervenschädigung vermieden werden. Lagerungsschäden sollten durch enge Kooperation mit der Anästhesie vermieden werden können.

Sind nach der Implantation einer Hüftendoprothese Nervenschäden eingetreten, ist eine rasche Diagnostik zur Diagnosesicherung erforderlich. Auf Grundlage einer angemessenen Diagnostik können Behandlungsoptionen abgewogen werden, um das Ausmaß der Dauerschädigung möglichst zu begrenzen. Bei Patienten mit eingetretenem Nervenschaden nach Hüftoperation ist eine Hilfsmittelversorgung häufig notwendig und zeitnah zu veranlassen.

Abstract

Nerve palsy following total hip arthroplasty is a rare complication. Developmental dysplasia of the hip, previous fracture treatment and medical comorbidities are characteristic risk factors. By accurate preparation of the patient and a careful operative technique nerve palsy can be avoided in most cases. Nerve palsy following poor patient positioning during the perioperative period should be avoided by close cooperation with anesthesiologists.

In cases of postoperative nerve palsy correct diagnostics should be carried out immediately. Further treatment options should be considered to minimize the damage. For patients with definite nerve palsy, devices such as a foot drop splint are often necessary and should be carried out as soon as possible.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland

    S. Kirschner, J. Goronzy,  K.-P. Günther & A. Hartmann

  2. Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    A. Storch

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  1. S. Kirschner
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  2. J. Goronzy
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  3. A. Storch
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  4. K.-P. Günther
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  5. A. Hartmann
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Correspondence to K.-P. Günther.

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Kirschner, S., Goronzy, J., Storch, A. et al. Vermeidung, Diagnostik und Therapie von Nervenläsionen nach Hüftendoprothesenimplantation. Orthopäde 40, 491–499 (2011). https://doi.org/10.1007/s00132-011-1758-x

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  • DOI: https://doi.org/10.1007/s00132-011-1758-x

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