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Gelenkerhaltende Hüftchirurgie im Erwachsenenalter

Intertrochantäre Femurosteotomie

Joint-preserving surgery of the adult hip

Intertrochanteric femoral osteotomy

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Zusammenfassung

Trotz guter Ergebnisse werden intertrochantäre Osteotomien aufgrund des Vormarschs der Endoprothetik immer seltener durchgeführt. Nach wie vor bestehen jedoch auch bei Erwachsenen gute Indikationen für diese gelenkerhaltenden Operationen. Detaillierte biomechanische Kenntnisse und eine subtile klinische Untersuchung sind Voraussetzung einer korrekten Indikationsstellung und Operationsplanung. Ziel der Operationen ist eine Verbesserung der Kongruenz der Gelenkpartner und Normalisierung der Krafteinleitung zur Entlastung geschädigter Knorpelareale. Unter Beachtung der therapeutischen Grundprinzipien werden bei Coxa valga et antetorta, Coxa vara epiphysaria, Schenkelhalspseudarthrose und Fehlstellungen des proximalen Femurs sehr gute Ergebnisse erzielt. Schlechtere Ergebnisse sind bei Hüftkopfnekrose und Koxarthrose in Abhängigkeit vom Arthrosegrad zu erwarten.

Abstract

Due to advances in total joint replacement, intertrochanteric osteotomy (ITO) is performed more infrequently in spite of good clinical results. Nevertheless, there are several good indications for this joint-preserving procedure in adults. Detailed biomechanical knowledge and precise clinical examination are prerequisites for correct indications and planning of ITO. The main target of this surgical procedure is improvement of joint congruency and normalization of load transfer to protect damaged cartilage. Very good results can be obtained in hip dysplasia, non-union of the femoral neck and proximal femoral deformities if the therapeutic principles are followed. Higher failure rates have to be expected in femoral head necrosis and osteoarthritis, depending on the degree of pre-existing cartilage damage.

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    H. Gollwitzer, J. Schauwecker, R. Burgkart, H. Rechl & R. von Eisenhart-Rothe

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  1. H. Gollwitzer
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  2. J. Schauwecker
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  3. R. Burgkart
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  4. H. Rechl
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  5. R. von Eisenhart-Rothe
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Correspondence to H. Gollwitzer.

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Gollwitzer, H., Schauwecker, J., Burgkart, R. et al. Gelenkerhaltende Hüftchirurgie im Erwachsenenalter. Orthopäde 41, 677–690 (2012). https://doi.org/10.1007/s00132-012-1958-z

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  • DOI: https://doi.org/10.1007/s00132-012-1958-z

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