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Ergebnisse nach FAIS-Chirurgie – wie ist die Evidenz?

Results after FAIS surgery—what is the evidence?

Zusammenfassung

Hintergrund

Die Behandlung des femoroazetabulären Impingement-Syndroms (FAIS) und dessen Folgeschäden hat sich, basierend auf einem stetig wachsenden besseren Verständnis des Krankheitsbildes und Verbesserungen in den operativen Techniken, in den letzten 20 Jahren verändert.

Fragestellung

Welche Evidenz liegt bei der Behandlung des FAIS vor?

Methoden

Analyse der vorliegenden Literatur, strukturierte Auswertung und Diskussion der relevanten Literatur.

Ergebnisse

Die Behandlung des FAIS hat sich zeitlich über mehrere Phasen entwickelt. In der ersten Phase wurde das Krankheitsbild und dessen offene Behandlung durch die chirurgische Hüftluxation beschrieben. Darauffolgend wurden erste vergleichende Studien zwischen offener, „mini-open“ und arthroskopischer Therapie publiziert. Nach Entwicklung von krankheitsspezifischen Patientenergebnismesssystemen (PROM) konnten die Belange des jungen, aktiveren Patientenkollektives erfasst werden. In den letzten Jahren wurden prospektiv-randomisierte, kontrollierte Studien zum Vergleich konservative versus operative Therapie des FAIS publiziert, die eine Überlegenheit der operativen Therapie zeigten, aber auch die Notwendigkeit, die evidenzbasierte Forschung vor allem in Bereich der konservativen Therapie des FAIS zu stärken.

Schlussfolgerung

Der Pathomechanismus und die Folgeschäden des FAIS sind in den letzten Jahren immer besser wissenschaftlich untersucht worden. Die Überlegenheit einer Operationstechnik kann man nicht nachweisen, die arthroskopische Technik hat geringere Komplikationsraten und eine schnellere Rekonvaleszenz. Auch in der Therapie des FAIS etablieren sich zunehmend klinische wichtige Ergebniswerte, um die klinische Relevanz für das Individuum zu erfassen.

Abstract

Background

The treatment of femoroacetabular impingement syndrome (FAIS) and its sequelae has changed over the past 20 years based on a steadily increasing understanding of the condition and improvements in surgical techniques.

Question

What is the evidence for the treatment of FAIS?

Methods

Analysis of the available literature, structured review, and discussion of the relevant literature.

Results

The treatment of FAIS has evolved over time through several phases. In the first phase, the clinical picture and its open treatment by surgical hip dislocation were described. Subsequently, the first comparative studies between open, mini-open, and arthroscopic therapy were published. After development of disease-specific patient-reported outcome measurement systems, the concerns of the young, more active patient population could be captured. In recent years, prospective randomized controlled trials comparing conservative versus surgical therapy of FAIS have been published, showing the superiority of surgical treatment and also the need to strengthen evidence-based research especially in the field of conservative treatment of FAIS.

Conclusion

The pathomechanism and sequelae of FAIS have been increasingly studied scientifically in recent years. The superiority of a particular surgical technique cannot be demonstrated; the arthroscopic technique has a lower complication rate and a faster convalescence. Clinically important outcome measures are also becoming increasingly established in the therapy of FAIS to capture the clinical relevance for the individual.

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Abbreviations

ADL:

„Activity of daily life“

CCD :

Corpus-Collum-Diaphysen-Winkel

CE-Winkel :

Centrum-Erker-Winkel

CIOV :

Klinische wichtige Ergebniswerte

FAIS :

Femoroazetabuläres Impingement-Syndrom

HASK :

Hüftarthroskopie

HOOS :

Hip Disability and Osteoarthritis Outcome Score

HOS :

Hip Outcome Score

HTEP :

Hüfttotalendoprothese

iHOT :

International Hip Outcome Tool

LCE :

Lateraler Centrum-Erker-Winkel

MCID :

„Minimally clinically important difference“

mHHS :

Modified Harris Hip Score

PASS :

„Patient acceptable symptom state“

PROM :

„Patient-reported outcome measures“

SCB :

„Substantial clinical benefit“

VAS :

Visuelle Analogskala

VCE-Winkel:

Ventraler Centrum-Erker-Winkel

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Correspondence to Stefan Fickert.

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S. Fickert und S. Landgraeber 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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Fickert, S., Landgraeber, S. Ergebnisse nach FAIS-Chirurgie – wie ist die Evidenz?. Orthopädie 51, 458–465 (2022). https://doi.org/10.1007/s00132-022-04263-4

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Schlüsselwörter

  • Arthroskopie
  • Evidenzbasierte Medizin
  • Ergebnis
  • Hüfte
  • Chirurgische Hüftluxation

Keywords

  • Arthroscopy
  • Evidence-based medicine
  • Outcome
  • Hip
  • Surgical hip dislocation