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Hüftendoprothetik bei Deformitäten des proximalen Femurs

Hip arthroplasty in the presence of proximal femoral deformity

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Zusammenfassung

Einleitung

Deformitäten des proximalen Femurs können zu schwerwiegenden funktionellen Defiziten und starken Schmerzen des ipsilateralen Hüftgelenkes führen, die schließlich die endoprothetische Versorgung dieses Gelenkes indizieren.

Vorgehen

Hüftendoprothetische Primäreingriffe bei einer komplex veränderten Anatomie des proximalen Femurs stellen eine technische Herausforderung für den Operateur dar. Die Deformität und die ihr zugrunde liegende Erkrankung, sei sie angeboren oder erworben, können die Präparation des Femurschaftes erschweren und die Wahl der Prothese, des operativen Zugangs sowie des postoperativen Physiotherapieregimes beeinflussen. Zudem kann ein mehrzeitiges operatives Vorgehen erforderlich werden, beispielsweise zur Entfernung von sich in situ befindenden Implantaten, zur Durchführung einer Femurosteotomie oder zum sicheren Ausschluss eines Infektes.

Diskussion

Jede endoprothetische Versorgung in Gegenwart eines deformierten proximalen Femurs erfordert ein individuelles Vorgehen unter Beachtung der Bedürfnisse des Patienten, der Ätiologie, der Lokalisation und der Geometrie der Femurdeformität, der Knochenqualität, des Zustandes der Weichteile, des Vorhandenseins von Implantaten im proximalen Femur, des infektiologischen Status und der Begleiterkrankungen des Patienten.

Abstract

Introduction

Proximal femoral deformities may result in pain in the ipsilateral hip joint and profound functional disability, ultimately requiring arthroplasty. 

Procedure

Primary hip replacement procedures in the presence of markedly altered anatomy of the proximal femur present a technical challenge for the orthopedic surgeon. The deformity and its underlying condition, whether congenital or acquired, may complicate canal preparation and affect the choices of implant, exposure and postoperative physiotherapy protocol. Furthermore, a two- or multi-stage treatment may be required, e.g. for implant removal, for femoral osteotomy or to rule out infection.

Discussion

Treatment strategies must be individually tailored, respecting patient needs, the etiology, the anatomic site and the geometry of the deformity encountered, bone quality, soft tissue deficits, the presence of retained implants in the proximal femur, infection status and comorbidities.

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Danksagung

Die Autoren danken Frau Christin Mannheim für die Erstellung der Abb. 1a und b.

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Authors and Affiliations

  1. Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungschirurgie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    A. Rakow,  P. Simon &  C. Perka

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  1. A. Rakow
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Correspondence to A. Rakow.

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Interessenkonflikt

C. Perka weist auf folgende Beziehungen hin: Berater für Smith & Nephew GmbH, Aesculap Implant Systems, DePuy Synthes Joint Reconstruction, Pluristem Therapeutics, Ceram Tec und Zimmer. A. Rakow und P. Simon geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Rakow, A., Simon, P. & Perka, C. Hüftendoprothetik bei Deformitäten des proximalen Femurs. Orthopäde 44, 510–522 (2015). https://doi.org/10.1007/s00132-015-3123-y

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