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Welchen Nutzen hat die Rekonstruktion der patientenindividuellen Anatomie beim endoprothetischen Hüftgelenkersatz?

What are the benefits of patient-specific reconstruction in total hip replacement?

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Zusammenfassung

Hintergrund

In der primären Endoprothetik des Hüftgelenkes wird der Erfolg der Operation maßgeblich von der Primärstabilität des Implantates und der Wiederherstellung der patientenindividuellen Gelenkbiomechanik bestimmt. Die dreidimensionale (Patho‑)Anatomie, Größenverhältnisse, Geometrie und Form des Azetabulums und proximalen Femurs sind bei Patienten mit fortgeschrittener Koxarthrose hochvariabel. Eine präzise präoperative Planung gilt daher als wesentliche Voraussetzung jedes Eingriffes.

Aktuelle Situation

Wissenschaftliche Ergebnisse belegen über Surrogatparameter (Offset und Beinlänge) patientenzentrierte Vorteile bei der Rekonstruktion einer funktionellen Gelenkgeometrie nach endoprothetischer Versorgung des Hüftgelenks. Die häufig in der Literatur zitierten „Zielzonen“ für die Positionierung der Pfanne stehen zunehmend im Fokus der wissenschaftlichen Diskussion. Individuell angepasste Zielzonen für die Implantatpositionierung ermöglichen potentiell eine Verringerung von Anschlagsphänomenen. Patienten nach Spondylodesen bzw. pathologischem spinopelvinem Alignement bedürfen im Besonderen einer patientenindividuellen Vorbereitung, Operationstechnik und Implantatwahl, um das Risiko für postoperative Instabilitäten zu verringern.

Abstract

Background

The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures.

Current situation

Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited “target zones” for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.

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Abbreviations

AI:

Anteinklination

AO :

Azetabuläres Offset

BL :

Beinlänge

CCD :

Zentrum-Kollum-Diaphysenwinkel

COR :

„Centre of rotation“

FA :

Femorale Anteversion

FO :

Femorales Offset

FSA :

Proximale femorale Achse

H :

Höhe

HO :

Hüftoffset

LA :

Biomechanischer Hebelarm des Hüftgelenks

LL :

Lendenlordosewinkel

LLD :

Beinlängendifferenz

LWS :

Lendenwirbelsäule

NSA :

„Neck shaft angle“

PE :

Polyethylen

PFA :

Becken-Femur-Winkel

PI :

Pelvic Incidence

PT :

Pelvic Tilt

SS :

Sacral Slope

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    Christian Merle M.Sc.,  Moritz M. Innmann,  Fabian Westhauser &  Tobias Renkawitz

  2. Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich

    Patrick Sadoghi

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  1. Christian Merle M.Sc.
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  2. Moritz M. Innmann
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Correspondence to Christian Merle M.Sc..

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Interessenkonflikt

C. Merle erhält von Heraeus, Johnson & Johnson und ZimmerBiomet Referentenhonorare bzw. institutionelle Forschungsförderung. P. Sadoghi erhält von Johnson & Johnson, Implantcast und Medacta Referentenhonorare bzw. institutionelle Forschungsförderungen. T. Renkawitz erhielt von DePuy, Zimmer, dem Bundesministerium für Bildung und Forschung, der Deutschen Arthrose-Hilfe, der Otto Bock Stiftung, dem Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung, der Stiftung Oskar-Helene-Heim Berlin und der Vielberth-Stiftung Referentenhonorare bzw. Forschungsförderung. Darüber hinaus ist er im Herausgeber-Board von Der Orthopäde und Der Unfallchirurg sowie im „international advisory board“ des Journal of the American Academy of Orthopaedic Surgeons. M. M. Innmann und F. Westhauser geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Merle, C., Innmann, M.M., Westhauser, F. et al. Welchen Nutzen hat die Rekonstruktion der patientenindividuellen Anatomie beim endoprothetischen Hüftgelenkersatz?. Orthopäde 50, 287–295 (2021). https://doi.org/10.1007/s00132-021-04087-8

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