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Die Hüftendoprothetik bei neuromuskulären Erkrankungen

Hip replacement in patients with neuromuscular disorders

  • Leitthema
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Zusammenfassung

Hintergrund

Die Implantation einer primären Hüftprothese bei Patienten mit neuromuskulären Grunderkrankungen ist eine besondere Herausforderung für Operateur und behandelndes Team.

Fragestellung

Bestehen Besonderheiten bei der Implantatauswahl und Implantationstechnik einer primären Hüftprothese bei Patienten mit neuromuskulärer Grunderkrankung?

Methoden

Auswertung der aktuellen Literatur unter Berücksichtigung der gegenwärtigen Lehrmeinung und eigener Erfahrungen.

Ergebnisse

Ein dezidiertes perioperatives, interdisziplinäres Management, fundiertes Wissen über die anatomischen und neurologischen Besonderheiten neuromuskulärer Erkrankungen sowie eine detaillierte präoperative Planung sind die Voraussetzungen für eine erfolgreiche Hüftprothesenimplantation.

Bei der Auswahl des Zugangswegs muß neben der Art der Lähmung (spastisch vs. paralytisch) auch eine mögliche Erweiterung des operativen Eingriffs (Weichteileingriffe, subtrochantäre Verkürzungsosteotomie, Pfannenplastik) berücksichtigt werden.

Nicht selten ist die Verwendung  spezieller Pfannenimplantate bei Patienten mit erhöhtem Luxationsrisiko und modularer Schäfte bei Patienten mit erhöhter Anteversion notwendig.

Schlussfolgerung

Die Implantation einer primären Hüftprothese bei Patienten mit neuromuskulären Erkrankungen ist eine vielversprechende Therapieoption. Bei fast allen Patienten kann eine Schmerzreduktion erreicht werden, jedoch hängt das Ausmaß der funktionellen Verbesserung oft von der Grunderkrankung und dem präoperativen Funktionszustand ab. Die Behandlung ist komplex und erfordert ein spezialisiertes Team.

Abstract

Background

Primary total hip replacement in patients with neuromuscular disorders is a challenge for the surgeon and the perioperative  team.

Objectives

Special considerations have to be given to implant selection as well as surgical approach and surgical technique.

Methods

The paper presents the current literature on  total hip replacements in patients with neuromuscular disorders  and the authors’ personal experience.

Results

Interdisciplinary perioperative management, special knowledge of the anatomic and neuromuscular pathology in patients with neuromuscular disorders, as well as detailed preoperative planning are essential to avoid complications.

The choice of the surgical approach should be based on the underlying neuromuscular pathology (spastic vs. paralytic) as well as the need to extend the surgery (soft tissue balancing, femoral shortening osteotomy, acetabular reconstruction).

In addition to standard implants special acetabular components might be required for patients with an increased risk of postoperative dislocation, and modular femoral components are indicated for patients with excessive femoral anteversion.

Conclusions

Total hip replacement is a successful treatment option for patients with neuromuscular disorders. While most patients will experience pain relief, functional improvements often depend on the underlying neuromuscular disorder and the preoperative function level. The treatment is complex and requires a specialized team to optimize the outcome of the surgery.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA

    L. Renner & F. Boettner

  2. Charite Universitätsmedizin, Center for Musculosceletal Surgery/Department of Orthopedic Surgery, Chariteplatz 1, 10117, Berlin, Germany

    V. Drwal

Authors
  1. L. Renner
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  2. V. Drwal
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  3. F. Boettner
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Corresponding author

Correspondence to F. Boettner.

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Interessenkonflikt

L. Renner, V. Drwal und F. Boettner 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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Renner, L., Drwal, V. & Boettner, F. Die Hüftendoprothetik bei neuromuskulären Erkrankungen. Orthopäde 44, 546–554 (2015). https://doi.org/10.1007/s00132-015-3126-8

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  • DOI: https://doi.org/10.1007/s00132-015-3126-8

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