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Impingement-Chirurgie als Prävention der Koxarthrose?

Impingement surgery for prevention of osteoarthritis of the hip?

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Der vorzeitige Knochen-zu-Knochen-Kontakt bei Bewegung des Hüftgelenks wird femoroazetabuläres Impingement (FAI) genannt. Die Unterscheidung der Ursache des Phänomens erfolgt anhand des Entstehungsortes. Anatomische Veränderungen des Übergangs von Femurkopf zu Schenkelhals führen zu einem sog. Cam-FAI, während azetabulär bedingter Kontakt der Gelenkpartner als Pincer-Impingement bezeichnet wird. Mischformen beider Morphologien sind häufig anzutreffen. Das Vorliegen eines FAI kann eine progrediente Schädigung des chondrolabralen Übergangs verursachen und gilt als Risikofaktor für die Entstehung einer vorzeitigen Koxarthrose. Verschiedene konservative und operative Behandlungsverfahren werden in der aktuellen Literatur diskutiert. Dem operativen Vorgehen liegt neben der Behebung der Ursache nach Möglichkeit die Adressierung von Begleitpathologien zugrunde. Inwiefern die Impingement-Chirurgie als Prävention einer Hüftgelenkarthrose erachtet werden kann, wird in diesem Beitrag anhand der aktuell relevanten Literatur diskutiert; es gibt diesbezüglich starke Hinweise. Eine abschließende Aussage, ob die Operation als Präventivmaßnahme angesehen werden kann, ist zum jetzigen Zeitpunkt nicht zu treffen.

Abstract

Premature bone to bone contact of the hip during joint motion is known as femoroacetabular impingement (FAI). The differentiation of the reason for this premature contact can be found in the zone between the femoral head and neck and is called Cam FAI. Acetabular irregularities can lead to a phenomenon known as Pincer impingement. Overlapping of these morphologies is frequent. The presence of FAI can lead to progressive damage to the acetabular labrum and adjacent hyaline cartilage and is discussed as a risk factor for early osteoarthritis of the hips. Various conservative and operative treatment procedures are discussed in the current literature. Surgical treatment includes the correction of the impingement cause as well as addressing concomitant pathologies. Whether impingement surgery can be considered for prevention of the emergence of osteoarthritis is discussed in this article with reference to the relevant literature. Recently published clinical studies indicate that surgery might be used as a preventive measure for osteoarthritis but the final evidence does not currently exist.

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Literatur

  1. Agricola R, Heijboer MP, Roze RH et al (2013) Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK). Osteoarthr Cartil 21:1514–1521

    Article  CAS  Google Scholar 

  2. Anonymous (2015) A multi-centre randomized controlled trial comparing arthroscopic osteochondroplasty and lavage with arthroscopic lavage alone on patient important outcomes and quality of life in the treatment of young adult (18–50) femoroacetabular impingement. BMC Musculoskelet Disord 16:64

    Article  Google Scholar 

  3. Bardakos NV, Villar RN (2009) Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br 91:162–169

    Article  CAS  Google Scholar 

  4. Beaule PE, Speirs AD, Anwander H et al (2017) Surgical correction of cam deformity in association with femoroacetabular impingement and its impact on the degenerative process within the hip joint. J Bone Joint Surg Am 99:1373–1381

    Article  Google Scholar 

  5. Brunner R, Maffiuletti NA, Casartelli NC et al (2016) Prevalence and functional consequences of femoroacetabular impingement in young male ice hockey players. Am J Sports Med 44:46–53

    Article  Google Scholar 

  6. Byrd JWT, Jones KS, Schmitz LMR et al (2016) Hip arthroscopy in the warrior athlete: 2 to 10 year outcomes. J Hip Preserv Surg 3:68–71

    Article  Google Scholar 

  7. Chaudhry H, Ayeni OR (2014) The etiology of femoroacetabular impingement: what we know and what we don’t. Sports Health 6:157–161

    Article  Google Scholar 

  8. Comba F, Yacuzzi C, Ali PJ et al (2016) Joint preservation after hip arthroscopy in patients with FAI. Prospective analysis with a minimum follow-up of seven years. Muscles Ligaments Tendons J 6:317–323

    PubMed  PubMed Central  Google Scholar 

  9. Fickert S, Aurich M, Albrecht D et al (2017) Biologic reconstruction of full sized cartilage defects of the hip: a guideline from the DGOU group “clinical tissue regeneration” and the hip committee of the AGA. Z Orthop Unfall 155:670–682

    Article  Google Scholar 

  10. Ganz R, Parvizi J, Beck M et al (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000096804.78689.c2

    Article  PubMed  Google Scholar 

  11. Gicquel T, Gedouin JE, Krantz N et al (2014) Function and osteoarthritis progression after arthroscopic treatment of femoro-acetabular impingement: a prospective study after a mean follow-up of 4.6 (4.2–5.5) years. Orthop Traumatol Surg Res 100:651–656

    Article  CAS  Google Scholar 

  12. Goodman DA, Feighan JE, Smith AD et al (1997) Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 79:1489–1497

    Article  CAS  Google Scholar 

  13. Griffin DR, Dickenson EJ, Wall PDH et al (2016) The feasibility of conducting a randomised controlled trial comparing arthroscopic hip surgery to conservative care for patients with femoroacetabular impingement syndrome: the FASHIoN feasibility study. J Hip Preserv Surg 3:304–311

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Haddad B, Konan S, Haddad FS (2014) Debridement versus re-attachment of acetabular labral tears: a review of the literature and quantitative analysis. Bone Joint J 96-b:24–30

    Article  CAS  Google Scholar 

  15. Harris JD, Erickson BJ, Bush-Joseph CA et al (2013) Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 6:207–218

    Article  Google Scholar 

  16. Hartofilakidis G, Bardakos NV, Babis GC et al (2011) An examination of the association between different morphotypes of femoroacetabular impingement in asymptomatic subjects and the development of osteoarthritis of the hip. J Bone Joint Surg Br 93:580–586

    Article  CAS  Google Scholar 

  17. Kowalczuk M, Yeung M, Simunovic N et al (2015) Does femoroacetabular impingement contribute to the development of hip osteoarthritis? A systematic review. Sports Med Arthrosc Rev 23:174–179

    Article  Google Scholar 

  18. Kuhns BD, Weber AE, Levy DM et al (2015) The natural history of femoroacetabular impingement. Front Surg 2:58

    PubMed  PubMed Central  Google Scholar 

  19. Mancini D, Fontana A (2014) Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement. Int Orthop 38:2057–2064

    Article  Google Scholar 

  20. Mansell NS, Rhon DI, Marchant BG et al (2016) Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial. BMC Musculoskelet Disord 17:60

    Article  Google Scholar 

  21. Nawabi DH, Bedi A, Tibor LM et al (2014) The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis. Arthroscopy 30:398–405

    Article  Google Scholar 

  22. Ng KC, Lamontagne M, Labrosse MR et al (2016) Hip joint stresses due to cam-type femoroacetabular impingement: a systematic review of finite element simulations. PLoS ONE 11:e147813

    Article  Google Scholar 

  23. Philippon MJ, Ho CP, Briggs KK et al (2013) Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med 41:1357–1362

    Article  Google Scholar 

  24. Stull JD, Philippon MJ, Laprade RF (2011) “At-risk” positioning and hip biomechanics of the Peewee ice hockey sprint start. Am J Sports Med 39(Suppl):29s–35s

    Article  Google Scholar 

  25. Van Klij P, Heerey J, Waarsing JH et al (2018) The prevalence of cam and pincer morphology and its association with development of hip osteoarthritis. J Orthop Sports Phys Ther 48:230–238

    Article  Google Scholar 

  26. Wall PD, Fernandez M, Griffin DR et al (2013) Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. J Inj Funct Rehabil 5:418–426

    Article  Google Scholar 

  27. Zhang C, Li L, Forster BB et al (2015) Femoroacetabular impingement and osteoarthritis of the hip. Can Fam Physician 61:1055–1060

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Orthopädie Karlshorst, Weseler Straße 17, 10318, Berlin, Deutschland

    G. Möckel

  2. Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    J. Löchel &  G. Wassilew

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  1. G. Möckel
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  2. J. Löchel
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  3. G. Wassilew
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Correspondence to G. Möckel.

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G. Möckel, J. Löchel und G. Wassilew geben an, dass kein Interessenkonflikt besteht.

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

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Möckel, G., Löchel, J. & Wassilew, G. Impingement-Chirurgie als Prävention der Koxarthrose?. Arthroskopie 31, 299–302 (2018). https://doi.org/10.1007/s00142-018-0224-8

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  • DOI: https://doi.org/10.1007/s00142-018-0224-8

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