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Persistierende oder wiederkehrende Beschwerden nach femoroazetabulärer Impingement-Chirurgie

Ursachen, Diagnostik und Therapie

Persistent or recurrent symptoms after surgery for femoroacetabular impingement syndrome (FAIS)

Pathology, diagnostics and therapy

Zusammenfassung

Hintergrund

Das femoroazetabuläre Impingement-Syndrom (FAIS) hat in den letzten beiden Jahrzehnten deutlich an Bedeutung gewonnen. Eine Vielzahl an Studien konnte zeigen, dass es bei ausbleibender Behandlung zu frühzeitiger Koxarthrose kommen kann. Mit zunehmendem Verständnis der Pathologie und verbesserten Operationstechniken hat die Hüftarthroskopie in der Therapie des FAIS und seiner Folgeschäden die Mehrzahl an offenen Techniken verdrängt. Durch die steigende Fallzahl an durchgeführten Hüftarthroskopien weltweit nimmt jedoch auch die Zahl an Patienten mit persistierenden oder wiederkehrenden Beschwerden nach FAIS-Chirurgie zu.

Ursachen

Als mögliche Versagensursachen gelten Komplikationen, wie knöcherne Fehlresektionen, Insuffizienzfrakturen an Schenkelhals oder Femurkopf, postoperative Adhäsionen, Versagen chondrolabraler oder kapsulärer Therapie, septische Arthritis, heterotope Ossifikationen oder eine falsche Indikationsstellung bei schon zu weit fortgeschrittener Koxarthrose. Die anspruchsvolle Lernkurve der Hüftarthroskopie ist mit einem gehäuften Auftreten dieser Pathologien vergesellschaftet.

Diagnostik

Qualitativ hochwertige Bildgebung spielt eine Schlüsselrolle bei der Entscheidung zur operativen Revision vs. weiterer konservativer Therapie. Verschiedene Lösungswege werden aufgezeigt, mit dem gemeinsamen Ziel der sicheren Erkennung und Behandlung der ursächlichen Pathologie. Ein unbefriedigendes Outcome nach FAIS-Chirurgie gilt es zu verbessern, auch zur langfristigen Erhaltung des Hüftgelenkes.

Abstract

Background

Femoroacetabular impingement syndrome (FAIS) has gained vast importance in the last two decades. Multiple studies have shown that if untreated, early osteoarthritis of the hip joint may result. Hip arthroscopy is one of the fastest growing procedures in the orthopedic cosmos, having already replaced the majority of (mini) open techniques in FAIS surgery. However, with the recent remarkable increase in the volume of hip arthroscopies performed worldwide, the number of patients with persistent or recurrent symptoms after FAIS surgery is also growing.

Pathology

Potential underlying pathologies are misresection of the bony deformity, insufficiency fracture of the femoral head neck junction or the femoral subchondral head itself (SIFFH), adhesions, failed chondrolabral or capsular treatment, septic arthritis, heterotopic ossification or a wrong indication in the case of osteoarthritis that is already too advanced. Most of these occur more often during the extensive learning curve for hip arthroscopy.

Diagnostics

High-quality imaging plays a key role in determining the need for revision surgery vs. further conservative treatment. Therapeutical avenues are shown with the common goal of proper detection and correction of the underlying pathology to address unsatisfactory FAIS treatment outcomes and ensure long-term survival of the native hip joint.

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Abbreviations

COX:

Cyclooxygenase

CRPS:

Komplexes regionales Schmerzsyndrom

FAIS:

Femoroazetabuläres Impingement-Syndrom

HO:

Heterotope Ossifikationen

MCID:

„Minimal clinically important difference“

NSAR:

Nichtsteroidale Antirheumatika

PASS:

„Patient acceptable symptomatic state“

PROM:

„Patient reported outcome measures“

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Correspondence to Ingo J. Banke.

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Interessenkonflikt

I.J. Banke gibt an, Instruktorentätigkeit (internationale Operationskurse und Workshops) und Beratertätigkeit (Produktanwendungstechniken) für Arthrex geleistet zu haben. Nichtfinanzielle Interessen: Sektionsleiter Gelenkerhaltende Hüftchirurgie, Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München. Mitgliedschaft: Hüftkomitee der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA), Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU). M. Ezechieli gibt an, dass kein finanzieller Interessenkonflikt besteht. Nichtfinanzielle Interessen: Chefarzt Vincenz Krankenhaus Paderborn, Standort Salzkotten. Mitglied der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA), Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU).

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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Banke, I.J., Ezechieli, M. Persistierende oder wiederkehrende Beschwerden nach femoroazetabulärer Impingement-Chirurgie. Orthopädie 51, 483–493 (2022). https://doi.org/10.1007/s00132-022-04255-4

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Schlüsselwörter

  • Arthroskopie
  • Coxarthrose
  • Hüfte
  • Revisionschirurgie
  • Behandlungsergebnis

Keywords

  • Arthroscopy
  • Coxarthrosis
  • Hip
  • Revision surgery
  • Treatment outcome