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Hüftendoprothetik

Rolle der computergesteuerten Navigation

Hip replacement

Role of computer-aided navigation

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Ausrichtung der Pfanne bezüglich Anteversion und Inklination ist der Schlüssel zu einer korrekten Implantation. Die herkömmlichen Planungs- und intraoperativen Ausrichtungsmethoden lassen keine exakte Positionierung zu. Durch die Computernavigation konnte eine genauere Positionierung der Komponenten in Relation zu anatomischen Strukturen erreicht werden. Nach mehreren Entwicklungsstufen von CT-basierter (CT: Computertomographie) Navigation über CT-freie, bildwandlergestützte Navigationsverfahren finden aktuell meist Systeme Anwendung, die mit Abnahme diverser Landmarken mit einem referenzierten Pointer ohne zusätzliche Strahlenbelastung auskommen. Die Abnahme des Symphysenpunkts (geometrisches Zentrum der Tubercula pubica), welcher insbesondere für die Anteversion der Pfanne entscheidend ist, gelingt nicht immer zuverlässig. In Zukunft könnte der Ansatz der 2D/3D-Rekonstruktion einige Probleme der aktuellen, noch verbesserbaren Navigationssysteme lösen.

Abstract

The positioning of the acetabular cup, specifically anteversion and inclination, is essential for correct implantation. The standard pre-operative and intra-operative positioning methods do not allow precise positioning. More exact anatomical positioning of the components can be achieved with computer-assisted navigation. Developments in computed tomography (CT) based navigation have led to the widespread use of CT-free imaging navigation with an integrated reference pointer to capture various anatomical landmarks, thereby significantly reducing radiation exposure. However, it is not always possible to precisely capture the symphysis point (the geometric center of the pubic tubercle), which is essential for proper anteversion of the acetabular cup. In the future the basic approach to 2D/3D imaging could resolve issues of the current navigation systems, as technical advancements allow for improvement.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Ruprechts-Karls-Universität Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    J. Franke, K. Wendl, J. Korber, P.A. Grützner & J. von Recum

  2. Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Schweiz

    G. Zheng

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  1. J. Franke
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  2. G. Zheng
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  4. J. Korber
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  5. P.A. Grützner
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  6. J. von Recum
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Franke, J., Zheng, G., Wendl, K. et al. Hüftendoprothetik. Trauma Berufskrankh 12, 101–106 (2010). https://doi.org/10.1007/s10039-010-1630-y

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