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Periprothetische Frakturen bei Hüfttotalendoprothese

Schaftwechsel

Periprosthetic fractures in total hip endoprosthesis

Stem revision

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Periprothetische Frakturen vom Typ Vancouver B2 und B3 machen einen Schaftwechsel erforderlich. Anhand einer prospektiven Studie an 32 periprothetischen Frakturen (22 Vancouver B2, 10 Vancouver B3) mit einem Mindest-Follow-up von 24 Monaten konnte bestätigt werden, dass mittels Schaftwechsel unter konsequenter Verwendung eines transfemoralen Zugangs und eines modularen, zementlosen, konischen Revisionsschafts reproduzierbar gute Ergebnisse hinsichtlich Frakturheilung, Stabilität des Prothesenschafts, Dislokationen, intraoperativen Frakturen und klinischen Resultaten erzielt werden können. Ein Schaftnachsinken wurde in keinem Fall beobachtet. Entsprechend der Klassifikation von Engh et al. sahen wir eine „bony-ingrowth fixation“ des Revisionsschafts in 28 und eine „stable fibrous fixation“ in 4 Fällen. Eine Dislokation und eine tiefe Beinvenenthrombose traten jeweils 1-mal, eine intraoperative Fraktur in keinem Fall auf. Der Harris-Hip-Score stieg nach der Operation kontinuierlich (3 Monate postoperativ: 59,2 ± 14,6 Punkte, 24 Monate postoperativ: 81,6 ± 16,5 Punkte). Entsprechend der Klassifikation von Beals u. Tower sind alle Ergebnisse dieser Studie als exzellent zu werten.

Abstract

Different operative techniques of stem revision for the treatment of periprosthetic fractures type Vancouver B2 and B3 are described. Our prospective study of 32 periprosthetic fractures (22 Vancouver type B2, 10 Vancouver type B3) with a follow-up period of at least 24 months showed that stem revision employing a transfemoral surgical approach and a modular, cementless, tapered and fluted revision stem led to reproducibly good results with respect to fracture healing, stability of the prosthesis stem, dislocation, intraoperative fracture, and clinical outcome. All fractures healed with a mean time of 14.5 ± 5.2 weeks. No cases of subsidence of the stem were observed and, according to the classification of Engh et al. concerning the biological fixation of the stem, bony ingrowth fixation was observed in 28 cases and stable fibrous fixation was observed in 4 cases. One dislocation and one case of deep vein thrombosis occurred, and there were no cases of intraoperative fracture. The Harris Hip Score rose continually (3 months postoperation: 59.2 ± 14.6 points; 24 months postoperation: 81.6 ± 16.5 points). According to the classification of Beals and Tower, all results were rated as excellent.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der Autor ist Berater der Firma Zimmer GmbH (Winterthur, Schweiz).

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Fink, B. Periprothetische Frakturen bei Hüfttotalendoprothese. Trauma Berufskrankh 14, 171–176 (2012). https://doi.org/10.1007/s10039-012-1897-2

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  • DOI: https://doi.org/10.1007/s10039-012-1897-2

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