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Aktuelle Indikationen zum aseptischen Hüft-TEP-Wechsel

Contemporary indications for aseptic revision total hip arthroplasty

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Zusammenfassung

Hintergrund

Perspektivisch wird die Zahl der endoprothetischen Primäreingriffe und Wechseloperationen weiter ansteigen. In Deutschland wurde im Jahr 2020 bei 27,5 % der Revisionseingriffe sowohl ein Wechsel der Pfannen- als auch der Schaftkomponente durchgeführt, bei 75 % der Revisionseingriffe wurde mindestens eine Komponente gewechselt. Zu den häufigsten Versagensmechanismen gehörten aseptische Lockerungen, Infektionen, periprothetische Frakturen, Instabilitäten und metallbedingte Pathologien.

Indikationen

Die aseptische Lockerung stellt nach wie vor den häufigsten Revisionsgrund dar. Jedoch haben sich die Indikationen für den Hüft-TEP-Wechsel im Laufe der Zeit verändert, wobei die Revisionen aufgrund einer aseptischen Lockerung abgenommen und die Revisionen aufgrund von Infektionen und periprothetischen Frakturen zugenommen haben. Der Anteil an Luxationen zeigte sich im vergangenen Jahrzehnt annähernd konstant, weist jedoch nationale Unterschiede auf. Metallassoziierte Pathologien werden weiterhin einen nicht unerheblichen Stellenwert bei den Revisionsindikationen einnehmen.

Abstract

Background

Hip arthroplasties and revision procedures will continue to rise over the next decades. In 2020 in Germany, 75% of all revision surgeries involved an exchange of at least one component; exchanges of all components were carried out in 27.5% of the revisions. The most common failure modes were aseptic loosening, infections, periprosthetic fractures, instabilities, and metal-related pathologies.

Indications

Aseptic loosening remains the most common reason for revision. However, the indications for hip arthroplasty revisions have changed over time, with a decrease in revisions due to aseptic loosening and an increase in revisions due to infection and periprosthetic fracture. The rate of dislocations remained approximately constant over the past decade, with international differences. Metal-associated pathologies will continue to play a significant role in revision hip arthroplasty.

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Abbreviations

AOANJRR:

Australian Orthopaedic Association National Joint Replacement Registry

ARMD :

„Adverse reactions to metal debris“

EPRD :

Endoprothesenregister Deutschland

MoM :

Metall-Metall

NJR :

National Joint Registry

PPFx :

Periprothetische Fraktur

SHAR :

Swedish Hip Arthroplasty Register

TEP :

Totalendoprothese

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Authors and Affiliations

  1. Orthopädische Universitätsklinik am RKU, Universitätsklinikum Ulm, Ulm, Deutschland

    Tobias Freitag & Heiko Reichel

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  1. Tobias Freitag
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Correspondence to Tobias Freitag.

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Interessenkonflikt

T. Freitag und H. Reichel 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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Freitag, T., Reichel, H. Aktuelle Indikationen zum aseptischen Hüft-TEP-Wechsel. Orthopädie 51, 609–618 (2022). https://doi.org/10.1007/s00132-022-04272-3

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