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Endoprothetik des älteren Menschen

Biomaterialien, Implantatwahl, Verankerungstechnik

Endoprostheses in the elderly

Biomaterials, implant selection and fixation technique

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Zusammenfassung

Der künstliche Gelenkersatz von Hüft- und Kniegelenk ist eine der größten Erfolgsgeschichten in der Orthopädie. Dank der kontinuierlichen Material- und Designverbesserung sind patientenassoziierte Probleme heute meist multifaktoriell und nur selten auf alleinige Materialprobleme zurückzuführen. Durch die Einführung von quervernetztem Polyäthylen (PE), antioxidativ stabilisiertem PE, Mischkeramiken, keramisierten Oberflächen und Schutzschichten ist das Verschleißproblem deutlich verringert, sodass eine weitere Verbesserung der Verschleißeigenschaften keine merkliche Verbesserung für den Patienten bedeuten wird. In der Prävention und Therapie von Infektionen und implantatassoziierten Unverträglichkeiten existiert hingegen noch Handlungsbedarf. Für das Kniegelenk wird, bedingt durch die Kontaktsituation, PE auch in der Zukunft als Gelenkartikulation nicht ersetzt werden können. Mit dem „mobile bearing“ (bewegliche Plattform) sowie dem „fixed bearing“ (festes Lager) stehen 2 etablierte erfolgreiche Philosophien zur Verfügung, die vergleichbar gute klinische Ergebnisse aufweisen. An der Hüfte wird sich die Keramik-Keramik-Paarung dann durchsetzen, wenn die korrekte Ausrichtung und Montage der Komponenten sichergestellt und damit Probleme wie Geräuschentwicklung und Bruch auf ein Minimum reduziert werden können. Die Korrosion von Konusverbindungen kann nur durch ein besseres mechanisches und elektrochemisches Verständnis der Limitation von Konusverbindungen reduziert werden. Die gleichzeitige Berücksichtigung aller Einflussfaktoren verbessert die Problematik maßgeblich wie auch die Verwendung nichtmetallischer Materialien. Beim älteren Patienten werden auch wirtschaftliche Zwänge im Gesundheitssystem die Wahl der Materialien bestimmen.

Abstract

The replacement of hip and knee joints is one of the greatest success stories in orthopedics. Due to continuous improvement of biomaterials and implant design, patient-associated problems are now mostly multifactorial and only rarely caused by the implant. Abrasion was significantly reduced by the introduction of highly cross-linked polyethylene (PE), antioxidant stabilized PE, new ceramics and the development of ceramic and protective surfaces. It is assumed that further reduction of frictional resistance will not lead to a significantly better clinical result: however, the problem of periprosthetic infections and implant-related incompatibility is still unsolved and remains challenging for biomaterial research. For the knee joint PE will be irreplaceable for joint articulation even in the future due to the contact situation. Mobile bearings and fixed bearings are two established successful philosophies, which have shown comparably good clinical results. For the hip joint, it is forecasted that ceramic-on-ceramic will be the system of the future if the correct positioning and mounting of the components can be solved so that the problems, such as development of noise and breakage can be reduced to a minimum. An in-depth understanding and detailed knowledge of the biomaterials by the surgeon can prevent implant-related problems. For elderly patients it is assumed that the economic burden on the public healthcare system will have the strongest impact on implant selection.

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Authors and Affiliations

  1. Institut für Biomechanik, TUHH Hamburg University of Technology, Denickestr. 15, 21073, Hamburg, Deutschland

    M. M. Morlock Ph.D.

  2. Klinik für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstr. 55, 45274, Essen, Deutschland

    M. Jäger

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Correspondence to M. M. Morlock Ph.D..

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Interessenkonflikt

M.M. Morlock ist Berater der Firmen DePuy und Zimmer. Das Institut für Biomechanik erhält projektbezogene finanzielle Unterstützung von den Firmen Peter Brehm und DePuy. M. Jäger gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Morlock, M.M., Jäger, M. Endoprothetik des älteren Menschen. Orthopäde 46, 4–17 (2017). https://doi.org/10.1007/s00132-016-3361-7

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