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Endoprothese bei Dysplasiecoxarthrose

Problemorientierte Versorgungsstrategien

Arthroplasty for osteoarthritis secondary to hip dysplasia

Problem-oriented treatment strategies

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Zusammenfassung

Hintergrund

Coxarthrosen aufgrund einer Hüftdysplasie sind häufig und können mit Deformitäten von Azetabulum und proximalem Femur assoziiert sein, die eine von der Standardendoprothetik abweichende Versorgung erforderlich machen.

Ziel der Arbeit

Basierend auf dem Schweregrad knöcherner und weichteiliger Veränderungen soll ein Überblick über gegenwärtige Versorgungsstrategien gegeben werden.

Material und Methodik

Zusätzlich zur Darstellung eigener Erfahrungen werden die Ergebnisse eines Literaturüberblicks präsentiert, die wesentliche Arbeiten zum Thema zusammenfassen.

Ergebnisse

Die sorgfältige präoperative Planung (basierend auf klinischer und röntgenologischer Untersuchung) hat große Bedeutung für ein gutes Operationsergebnis. Die Pfannenpositionierung möglichst nahe am primären Hüftzentrum zeigt die besten Ergebnisse. Eine Pfannendachaugmentation oder eine verstärkte Medialisierung unterstützen bei ausgeprägter Dysplasie die erforderliche knöcherne Überdachung des Implantates. Bei hoher Hüftluxation kann die subtrochantäre Verkürzungsosteotomie die Reposition erleichtern und das Risiko eines Nervenschadens reduzieren.

Diskussion

Auch wenn die postoperative Komplikationsrate bei Dysplasieversorgungen generell etwas höher als bei idiopathischer Arthrose ist, sind mittel- und langfristige Ergebnisse hinsichtlich Funktion und Standzeiten weitgehend vergleichbar.

Abstract

Background

Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia.

Objectives

Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities.

Materials and methods

Review of relevant clinical studies, meta-analyses, and presentation of our own approach.

Results

Pre-operative planning (based on a thorough clinical and radiographic examination) is essential. Acetabular reconstruction close to the primary acetabulum should always be intended. Roof augmentation and/or cup medialization can support stable bony implant fixation. Subtrochanteric shortening osteotomy of the femur is a demanding but reliable technique that avoids nerve damage in cases where inappropriate lengthening would be necessary (i.e., high riding dislocation).

Conclusions

Although the post-operative complication rate is elevated after THA for dysplastic hips compared with primary osteoarthritis, the overall functional results and implant survival are comparable.

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  1. UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland

    K.P. Günther, M. Stiehler, J. Goronzy, W. Schneiders & A. Hartmann

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K.P. Günther, M. Stiehler, und A. Hartmann geben an, für Forschungsprojekte im Zusammenhang mit Endoprothetik Drittmittel von den Firmen Aesculap, Link und Zimmer erhalten zu haben. J. Goronzy und W. Schneider geben an, dass kein Interessenkonflikt vorliegt.

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Günther, K., Stiehler, M., Goronzy, J. et al. Endoprothese bei Dysplasiecoxarthrose. Orthopäde 44, 497–509 (2015). https://doi.org/10.1007/s00132-015-3106-z

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