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Welche Hüftgelenkgleitpaarung für welchen Patienten?

Tribologie der Zukunft

Which hip articulation bearing for which patient?

Tribology of the future

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Zusammenfassung

Der Hüftgelenkersatz weist seit Charnley’s „Low-friction“-Philosophie hervorragende Langzeitergebnisse auf. Die aseptische Osteolyse als Hauptrevisionsgrund führte zur Reduktion des Abriebvolumens als Hauptziel. Die Gelenkluxation als zweithäufigster Revisionsgrund wurde durch die Vergrößerung des Kopfdurchmessers adressiert. Dies ist bei Paarungen mit Polyethylen nur äußerst begrenzt möglich: größere Köpfe weisen einen erhöhten Abrieb auf (auch bei quervernetztem PE). Bei Hart-hart-Paarungen dagegen nehmen mit zunehmendem Kopfdurchmesser unter Simulatorbedingungen der Verschleiß und die Luxationsrate ab, was zum vermehrten klinischen Einsatz führte. Hierbei wurde nicht ausreichend berücksichtigt, dass beim Zusammenbruch des Schmierfilms ein sprunghafter, mit Kopfgröße zunehmender Anstieg an Verschleiß und Reibung auftritt. Derartige ungünstige Bedingungen können klinisch durch vielerlei Faktoren bedingt sein. Als Konsequenz kommt es derzeit nun zu unerwarteten klinischen Komplikationen. Standardisierte präklinische Testungen sind eine Minimalanforderung, müssen dringend verbessert werden und sind trotzdem kein Garant für den klinischen Erfolg neuer Materialien und Designs. Die Zukunft der Tribologie liegt in der Vermeidung ungünstiger Bedingungen beim Patienten, in der Weiterentwicklung und optimierten Anwendung bereits erprobter und nicht in neuen Materialien.

Abstract

Replacement of the hip joint has become an exceptionally successful procedure since the inauguration of the low friction principle by Charnley. Aseptic osteolysis and joint dislocation have been addressed by the development of wear-optimized materials and the introduction of larger heads. As an increase in head diameter against polyethylene causes wear increase, larger hard-on-hard bearings were introduced, which exhibit reduced wear and reduced dislocation risk with increasing head diameter. These findings were derived from standard simulator testing, not sufficiently considering the risk of fluid film breakdown under adverse conditions, which can cause a dramatic increase in wear and friction proportional to the head diameter. Such adverse conditions can occur clinically in patients due to several factors and have caused the presently observed unexpected problems with these new designs. Standardized preclinical testing has to be viewed as a minimum requirement but certainly not as a guarantee for the clinical success of new materials and designs even if the testing is adapted to the current patient requirements, which is presently not the case. The future of tribology lies in the prevention of adverse conditions in patients, the improvement and optimized use of proven existing materials and not in the use of new materials.

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Interessenkonflikt

Es besteht kein direkter Interessenkonflikt. Der Erstautor ist Berater der Firmen Aesculap, DePuy und Zimmer. Das Institut für Biomechanik erhält projektbezogene finanzielle Unterstützung von den Firmen Aesculap, Ceramtec und DePuy.

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Authors and Affiliations

  1. Institut für Biomechanik, TU Hamburg-Harburg, Denickestrasse, 21073, Hamburg, Deutschland

    M.M. Morlock & N. Bishop

  2. Endolab GmbH, Rosenheim, Deutschland

    C. Kaddick

Authors
  1. M.M. Morlock
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  2. N. Bishop
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  3. C. Kaddick
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Correspondence to M.M. Morlock.

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Morlock, M., Bishop, N. & Kaddick, C. Welche Hüftgelenkgleitpaarung für welchen Patienten?. Orthopäde 40, 1061–1067 (2011). https://doi.org/10.1007/s00132-011-1849-8

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